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New Hampshire rates for HCPCS L5702

Replacement, socket, hip disarticulation, including hip joint, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,079.08 / $3,079.08 / $3,694.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,389.30 / $2,414.42 / $3,682.99
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,468.44 / $5,468.44 / $6,482.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,171.15 / $3,171.15 / $3,327.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,745.37 / $3,745.37 / $3,745.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,734.12 / $2,734.12 / $3,745.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,427.55 / $4,427.55 / $13,665.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,818.76 / $2,728.14 / $4,357.09
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,095.66 / $4,505.22 / $5,733.92