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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
$444.29 / $444.29 / $533.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.27 / $344.76 / $444.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$789.04 / $789.04 / $935.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.88 / $359.88 / $377.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.78 / $400.78 / $400.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.57 / $292.57 / $427.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.86 / $638.86 / $1,971.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.41 / $421.78 / $638.86
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$590.97 / $650.07 / $827.36