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New Hampshire rates for HCPCS L2628

Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,239.35 / $1,239.35 / $1,487.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$824.09 / $961.72 / $1,336.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,201.10 / $2,201.10 / $2,609.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,137.16 / $1,137.16 / $1,204.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,179.41 / $1,179.41 / $1,179.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$860.97 / $860.97 / $1,214.79
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,782.13 / $1,782.13 / $5,500.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$732.07 / $1,098.09 / $1,538.63
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,648.55 / $1,813.41 / $2,307.96