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New Hampshire rates for HCPCS L5637

Addition to lower extremity, below knee (BK), total contact

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $223.87 / $269.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $223.87 / $302.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $436.52 / $501.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $208.93 / $218.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $234.42 / $295.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $169.82 / $234.42
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $346.74 / $616.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $229.09 / $263.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $213.80 / $346.74
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $354.81 / $575.44