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New Hampshire rates for HCPCS L5230

Above knee (AK), for proximal femoral focal deficiency, constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,697.42 / $2,697.42 / $3,236.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,039.02 / $2,093.14 / $2,739.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,790.59 / $4,790.59 / $5,678.77
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,776.59 / $2,776.59 / $2,913.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,853.06 / $2,853.06 / $2,853.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,082.73 / $2,082.73 / $2,938.65
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,878.73 / $3,878.73 / $11,971.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,593.32 / $2,389.96 / $3,508.45
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,587.99 / $3,946.79 / $5,023.18