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New Hampshire rates for HCPCS L5647

Addition to lower extremity, below knee (BK), suction socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$716.78 / $716.78 / $860.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.37 / $556.20 / $718.97
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.75 / $954.75 / $954.75
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,273.00 / $1,273.00 / $1,509.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.25 / $581.25 / $609.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$596.58 / $596.58 / $596.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.50 / $435.50 / $596.58
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,030.69 / $1,030.69 / $3,181.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.58 / $653.02 / $714.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.39 / $635.08 / $754.08
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$953.42 / $1,048.76 / $1,334.79