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New Hampshire rates for HCPCS L5822

Addition, endoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,534.46 / $1,534.46 / $1,841.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$998.62 / $1,190.71 / $1,534.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,725.19 / $2,725.19 / $3,230.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,242.91 / $1,242.91 / $1,304.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,367.82 / $1,367.82 / $1,367.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$998.51 / $998.51 / $1,458.16
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,206.46 / $2,206.46 / $6,810.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$628.52 / $1,347.44 / $1,529.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$906.38 / $1,359.56 / $1,614.31
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.08 / $2,245.19 / $2,857.51