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New Hampshire rates for HCPCS L5642

Addition to lower extremity, above knee (AK), leather socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.71 / $418.71 / $502.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.91 / $334.63 / $418.71
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$743.63 / $743.63 / $881.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$454.30 / $454.30 / $474.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.41 / $530.41 / $530.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.20 / $387.20 / $530.41
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.07 / $602.07 / $1,858.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.32 / $370.99 / $532.23
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$556.95 / $612.65 / $779.73