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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
$1,402.49 / $1,402.49 / $1,682.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$834.25 / $1,088.30 / $1,403.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,490.80 / $2,490.80 / $2,952.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,131.33 / $1,131.33 / $1,192.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,167.30 / $1,167.30 / $1,167.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$852.13 / $852.13 / $1,244.40
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,016.70 / $2,016.70 / $6,224.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$828.42 / $1,242.64 / $1,475.47
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,865.53 / $2,052.08 / $2,611.73