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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
$285.74 / $285.74 / $342.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.46 / $221.73 / $285.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.46 / $507.46 / $601.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.11 / $266.11 / $278.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.26 / $366.26 / $366.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $267.37 / $372.99
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.87 / $410.87 / $1,268.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.78 / $253.17 / $335.50
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.08 / $418.09 / $532.11