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New Hampshire rates for HCPCS L5697

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

Facilitymedian $132 · 10th–90th $72–$1550%20%10th90th$132Professionalmedian $85 · 10th–90th $49–$1200%20%10th90th$85$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
$72.44 / $72.44 / $87.10
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $61.66 / $107.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $141.25 / $158.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $57.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $60.26 / $95.50
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $43.65 / $60.26
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $208.93
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$29.51 / $66.07 / $72.44
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $74.13 / $112.20
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $123.03 / $181.97