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New Hampshire rates for HCPCS L5614

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,119.53 / $1,119.53 / $1,343.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$868.74 / $887.92 / $1,119.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,988.29 / $1,988.29 / $2,356.92
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,111.77 / $1,111.77 / $1,161.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,317.79 / $1,317.79 / $1,317.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.99 / $961.99 / $1,357.32
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,609.83 / $1,609.83 / $4,968.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.29 / $991.94 / $1,367.60
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,489.16 / $1,638.08 / $2,084.82