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New Hampshire rates for HCPCS L5671

Addition to lower extremity, below knee (BK)/above knee (AK) suspension locking mechanism (shuttle, lanyard, or equal), excludes socket insert

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$336.16 / $336.16 / $403.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.85 / $266.61 / $402.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$597.02 / $597.02 / $707.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$381.05 / $412.43 / $412.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.63 / $380.63 / $380.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.86 / $277.86 / $405.78
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$483.38 / $483.38 / $1,491.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.21 / $319.13 / $483.38
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.14 / $491.85 / $626.00