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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
$2,691.53 / $2,691.53 / $3,235.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,691.53 / $5,011.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,897.79 / $5,248.07 / $5,888.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,754.23 / $2,754.23 / $2,884.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $2,884.03 / $3,548.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,884.03
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,168.69 / $4,168.69 / $7,244.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $3,090.30 / $3,467.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,570.40 / $4,168.69
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $4,265.80 / $6,918.31