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New Hampshire rates for HCPCS L5613

Addition To Lower Extremity Endoskeletal System Above Knee- Knee Disarticulation 4 Bar Linkage With Hydraulic Swing Phase Control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,208.29 / $2,208.29 / $2,649.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,313.57 / $1,713.59 / $2,243.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,921.91 / $3,921.91 / $4,649.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,788.71 / $1,788.71 / $1,877.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.78 / $1,902.78 / $1,902.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,389.03 / $1,389.03 / $1,959.86
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,175.39 / $3,175.39 / $9,800.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,304.40 / $1,956.59 / $3,296.55
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,937.38 / $3,231.12 / $4,112.33