go back

New Hampshire rates for HCPCS L5658

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

Facilitymedian $513 · 10th–90th $288–$6170%20%40%10th90th$513Professionalmedian $347 · 10th–90th $219–$4900%20%10th90th$347$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $346.74
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $281.84 / $489.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$512.86 / $549.54 / $630.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $269.15 / $269.15
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $363.08 / $371.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $269.15 / $363.08
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $446.68 / $812.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $288.40 / $331.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $331.13 / $446.68
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $489.78 / $724.44