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New Hampshire rates for HCPCS L5649

Addition to lower extremity, ischial containment/narrow M-L socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,286.71 / $1,286.71 / $1,544.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$998.46 / $1,071.32 / $1,539.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,285.19 / $2,285.19 / $2,708.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,458.34 / $1,711.10 / $1,711.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,800.00 / $1,800.00 / $1,800.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,314.00 / $1,314.00 / $1,800.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,850.22 / $1,850.22 / $5,710.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$760.04 / $1,140.05 / $1,717.33
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,711.52 / $1,882.67 / $2,396.13