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New Hampshire rates for HCPCS L5639

Addition To Lower Extremity Below Knee Wood Socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,010.28 / $1,010.28 / $1,212.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$611.92 / $783.96 / $1,010.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,794.25 / $1,794.25 / $2,126.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$822.12 / $822.12 / $858.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.50 / $870.50 / $870.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.47 / $635.47 / $896.62
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,452.72 / $1,452.72 / $4,483.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$596.75 / $895.13 / $1,062.85
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,343.83 / $1,478.21 / $1,881.36