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New Hampshire rates for HCPCS L5685

Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each

Facilitymedian $155 · 10th–90th $85–$1820%10%20%10th90th$155Professionalmedian $102 · 10th–90th $68–$1410%20%10th90th$102$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $85.11 / $102.33
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $83.18 / $125.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $165.96 / $186.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $95.50
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $100.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $245.47
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$42.66 / $95.50 / $104.71
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $104.71 / $131.83
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $213.80