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New Hampshire rates for HCPCS L5650

Additions to lower extremity, total contact, above knee (AK) or knee disarticulation socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.92 / $329.92 / $395.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$256.01 / $329.92 / $394.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$585.94 / $585.94 / $694.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.30 / $355.30 / $373.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.03 / $379.03 / $379.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.69 / $276.69 / $379.03
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.41 / $474.41 / $1,464.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.88 / $292.32 / $440.33
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$438.85 / $482.74 / $614.39