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New Hampshire rates for HCPCS L5210

Above Knee Short Prosthesis No Knee Joint (Stubbies) With Foot Blocks No Ankle Joints Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,782.68 / $1,782.68 / $2,139.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,300.64 / $1,599.25 / $2,132.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,166.04 / $3,166.04 / $3,753.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,760.19 / $1,760.19 / $1,858.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.89 / $1,819.89 / $1,819.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,328.52 / $1,328.52 / $1,940.10
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,563.40 / $2,563.40 / $7,911.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,776.27 / $1,776.27 / $1,776.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,053.00 / $1,579.50 / $2,188.75
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,371.25 / $2,608.38 / $3,319.75