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New Hampshire rates for HCPCS L5814

Addition, endoskeletal knee-shin system, polycentric, hydraulic swing phase control, mechanical stance phase lock

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,463.94 / $2,463.94 / $2,956.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,911.96 / $1,954.17 / $2,947.18
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,375.91 / $4,375.91 / $5,187.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,555.87 / $2,693.73 / $2,693.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,502.67 / $2,502.67 / $2,502.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,826.95 / $1,826.95 / $2,667.97
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,542.98 / $3,542.98 / $10,935.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,455.40 / $2,183.09 / $3,009.91
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,277.42 / $3,605.16 / $4,588.39