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New Hampshire rates for HCPCS L5658

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $288.40 / $346.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $269.15 / $489.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $549.54 / $630.96
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
$363.08 / $363.08 / $371.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $363.08
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $776.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $288.40 / $331.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $269.15 / $446.68
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $457.09 / $724.44