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New Hampshire rates for HCPCS L5656

Addition to lower extremity, socket insert, knee disarticulation (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $251.19 / $302.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $251.19 / $501.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $489.78 / $562.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $269.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $338.84 / $338.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $338.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $389.05 / $691.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $302.00 / $331.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $239.88 / $389.05
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $645.65