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New Hampshire rates for HCPCS L5695

Addition to lower extremity, above knee (AK), pelvic control, sleeve suspension, neoprene or equal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.09 / $124.09 / $148.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.29 / $102.01 / $147.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$220.38 / $220.38 / $261.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.12 / $120.12 / $124.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.31 / $122.31 / $122.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.29 / $89.29 / $130.38
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.43 / $178.43 / $550.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.30 / $109.94 / $147.10
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.06 / $181.57 / $231.08