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New Hampshire rates for HCPCS L5640

Addition to lower extremity, knee disarticulation, leather socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $436.52 / $512.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $436.52 / $851.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $831.76 / $954.99
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $467.74 / $467.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $575.44 / $575.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $575.44
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $676.08 / $1,174.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $501.19 / $575.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $407.38 / $676.08
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $691.83 / $1,096.48