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New Hampshire rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$369.64 / $369.64 / $443.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.08 / $289.07 / $442.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$656.48 / $656.48 / $778.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.40 / $352.40 / $369.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.82 / $499.82 / $499.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.87 / $364.87 / $499.82
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531.52 / $531.52 / $1,640.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.20 / $382.03 / $433.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.34 / $327.51 / $435.06
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$491.69 / $540.86 / $688.37