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New Hampshire rates for HCPCS L8417

Prosthetic sheath/sock, including a gel cushion layer, below knee (BK) or above knee (AK), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.82 / $49.82 / $59.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.65 / $39.54 / $59.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.48 / $88.48 / $104.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.73 / $54.54 / $54.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.66 / $50.66 / $50.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.97 / $36.97 / $54.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.64 / $71.64 / $221.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.43 / $44.14 / $74.37
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.80 / $63.58 / $80.92