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New Hampshire rates for HCPCS L5706

Custom shaped protective cover, knee disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $724.44 / $870.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $660.69 / $1,000.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,380.38 / $1,584.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $954.99 / $954.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $691.83 / $954.99
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,949.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $741.31 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $676.08 / $1,122.02
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,148.15 / $1,819.70