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New Hampshire rates for HCPCS L5220

Above knee (AK), short prosthesis, no knee joint (stubbies), with articulated ankle/foot, dynamically aligned, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,913.32 / $1,913.32 / $2,295.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,478.41 / $1,542.49 / $1,986.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,398.02 / $3,398.02 / $4,028.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,988.34 / $1,988.34 / $2,112.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,482.86 / $2,482.86 / $2,482.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,812.49 / $1,812.49 / $2,497.52
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,751.23 / $2,751.23 / $8,491.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,018.03 / $2,264.35 / $2,477.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,130.16 / $1,695.24 / $2,487.91
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,545.01 / $2,799.51 / $3,563.01