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New Hampshire rates for HCPCS L5631

Addition to lower extremity, above knee (AK) or knee disarticulation, acrylic socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$395.92 / $395.92 / $475.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$287.66 / $307.22 / $396.31
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$703.15 / $703.15 / $833.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.89 / $319.89 / $336.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.53 / $329.53 / $329.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.56 / $240.56 / $351.29
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$569.30 / $569.30 / $1,757.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.86 / $350.79 / $591.03
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$526.64 / $579.29 / $737.30