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New Hampshire rates for HCPCS L5626

Addition to lower extremity, test socket, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $389.05 / $467.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $380.19 / $549.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $758.58 / $870.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $346.74 / $354.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $512.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $489.78
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $602.56 / $1,047.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $380.19 / $426.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $371.54 / $602.56
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $616.60 / $1,000.00