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New Hampshire rates for HCPCS L5686

Addition to lower extremity, below knee (BK), back check (extension control)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.74 / $40.74 / $48.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $34.67 / $64.57
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $79.43 / $89.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $38.90 / $40.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $44.67 / $53.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $33.11 / $44.67
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $63.10 / $109.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.05 / $40.74 / $45.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $38.90 / $63.10
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $102.33