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New Hampshire rates for HCPCS L5620

Addition to lower extremity, test socket, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$250.52 / $250.52 / $300.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.02 / $194.40 / $255.30
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.68 / $333.68 / $333.68
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.91 / $444.91 / $527.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.82 / $202.82 / $212.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.59 / $209.59 / $209.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.00 / $153.00 / $223.43
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.23 / $360.23 / $1,111.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.61 / $228.23 / $249.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.97 / $221.96 / $256.52
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.23 / $366.55 / $466.52