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New Hampshire rates for HCPCS L5696

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic joint

Facilitymedian $288 · 10th–90th $158–$3470%20%40%10th90th$288Professionalmedian $191 · 10th–90th $112–$2690%20%10th90th$191$100.0$200.0$500.0$1.0K

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
$158.49 / $158.49 / $190.55
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $151.36 / $245.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $309.03 / $354.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $134.90 / $134.90
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $208.93
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $138.04
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $251.19 / $457.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $151.36 / $165.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $169.82 / $251.19
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $407.38