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New Hampshire rates for HCPCS L5696

Addition To Lower Extremity Above Knee Or Knee Disarticulation Pelvic Joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$160.24 / $160.24 / $192.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.48 / $124.34 / $160.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$284.58 / $284.58 / $337.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.38 / $133.38 / $141.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.76 / $138.76 / $138.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.29 / $101.29 / $147.91
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.42 / $230.42 / $711.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.65 / $141.97 / $170.72
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.15 / $234.47 / $298.41