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New Hampshire rates for HCPCS L5728

Addition, exoskeletal knee-shin system, single axis, fluid swing and stance phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,144.13 / $2,144.13 / $2,572.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,323.56 / $1,663.80 / $2,144.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,807.96 / $3,807.96 / $4,513.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,715.30 / $1,715.30 / $1,822.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,050.41 / $2,050.41 / $2,050.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,496.80 / $1,496.80 / $2,050.41
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,083.14 / $3,083.14 / $9,516.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,266.50 / $1,899.75 / $2,255.71
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,852.04 / $3,137.24 / $3,992.86