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New Hampshire rates for HCPCS L5677

Additions to lower extremity, below knee (BK), knee joints, polycentric, pair

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $446.68 / $537.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $380.19 / $537.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $851.14 / $977.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $363.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $575.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $295.12 / $398.11
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $691.83 / $1,202.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $398.11 / $446.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $426.58 / $691.83
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $707.95 / $1,122.02