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New Hampshire rates for HCPCS L5250

Hip disarticulation, Canadian type; molded socket, hip joint, single axis constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,801.89 / $3,801.89 / $4,466.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,754.23 / $3,715.35 / $6,456.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,760.83 / $7,244.36 / $8,317.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,801.89 / $3,801.89 / $3,801.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,365.16 / $4,365.16 / $4,897.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $4,365.16
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,888.44 / $5,888.44 / $10,232.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $4,265.80 / $4,677.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $3,548.13 / $5,888.44
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $6,025.60 / $9,549.93