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New Hampshire rates for HCPCS L5828

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,544.61 / $2,544.61 / $3,053.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,566.87 / $1,974.56 / $2,552.38
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,163.45 / $3,163.45 / $3,163.45
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,519.21 / $4,519.21 / $5,357.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,063.67 / $2,063.67 / $2,162.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,117.90 / $2,117.90 / $2,117.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,546.07 / $1,546.07 / $2,117.90
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,659.00 / $3,659.00 / $11,293.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,503.06 / $2,254.58 / $2,677.03
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,384.73 / $3,723.20 / $4,738.62