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New Hampshire rates for HCPCS L5697

Addition To Lower Extremity Above Knee Or Knee Disarticulation Pelvic Band

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.34 / $72.34 / $86.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.28 / $56.13 / $72.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.47 / $128.47 / $152.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.87 / $57.87 / $61.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.21 / $60.21 / $60.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.95 / $43.95 / $64.19
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.02 / $104.02 / $321.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.73 / $64.09 / $76.09
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.22 / $105.84 / $134.71