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New Hampshire rates for HCPCS L5700

Replacement, socket, below knee (BK), molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,969.26 / $1,969.26 / $2,363.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,528.10 / $1,544.16 / $2,355.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,497.40 / $3,497.40 / $4,145.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,055.03 / $2,055.03 / $2,097.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,400.00 / $2,400.00 / $2,400.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,752.00 / $1,752.00 / $2,570.55
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,831.69 / $2,831.69 / $8,740.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,163.21 / $1,744.81 / $2,467.67
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,619.42 / $2,881.37 / $3,667.20