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New Hampshire rates for HCPCS L5673

Addition To Lower Extremity Below Knee/Above Kneecustom Fabricated From Existing Mold Or Prefabricated Socket Insert Silicone Gel Elastomeric Or Equal For Use With Locking Mechanism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$533.17 / $533.17 / $639.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$376.57 / $413.73 / $637.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$946.88 / $946.88 / $1,122.43
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$510.00 / $510.00 / $511.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.15 / $501.15 / $501.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.84 / $365.84 / $587.67
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$766.66 / $766.66 / $2,366.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.93 / $472.40 / $616.57
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$709.20 / $780.12 / $992.88