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New Hampshire rates for HCPCS L5726

Addition, exoskeletal knee-shin system, single axis, external joints, fluid swing phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,523.80 / $1,523.80 / $1,828.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,062.35 / $1,182.43 / $1,523.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,706.24 / $2,706.24 / $3,207.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,275.56 / $1,275.56 / $1,332.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,606.19 / $1,606.19 / $1,606.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,172.52 / $1,172.52 / $1,654.38
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,191.12 / $2,191.12 / $6,762.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$900.08 / $1,350.11 / $2,274.71
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,026.88 / $2,229.57 / $2,837.63