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New Hampshire rates for HCPCS L5643

Addition to lower extremity, hip disarticulation, flexible inner socket, external frame

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $1,412.54 / $1,698.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,202.26 / $1,819.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $2,691.53 / $3,090.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,122.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,819.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $851.14 / $1,174.90
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,187.76 / $3,801.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $1,230.27 / $1,412.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,318.26 / $2,187.76
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $2,238.72 / $3,548.13