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New Hampshire rates for HCPCS L5624

Addition to lower extremity, test socket, above knee (AK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$327.60 / $327.60 / $393.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.13 / $254.20 / $327.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$581.80 / $581.80 / $689.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.64 / $264.64 / $278.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.77 / $311.77 / $311.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.60 / $227.60 / $332.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$471.06 / $471.06 / $1,453.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.50 / $290.26 / $344.65
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.76 / $479.34 / $610.05