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New Hampshire rates for HCPCS L5629

Addition to lower extremity, below knee, acrylic socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.37 / $286.37 / $343.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.75 / $222.21 / $286.64
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$381.43 / $381.43 / $381.43
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$508.57 / $508.57 / $602.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.73 / $231.73 / $243.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.05 / $248.05 / $248.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.08 / $181.08 / $264.43
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.77 / $411.77 / $1,270.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.15 / $253.72 / $293.23
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.91 / $419.00 / $533.27