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New Hampshire rates for HCPCS L5830

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,709.84 / $1,709.84 / $2,051.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,113.33 / $1,326.80 / $1,709.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,036.67 / $3,036.67 / $3,599.67
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,376.42 / $1,376.42 / $1,453.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,654.54 / $1,654.54 / $1,654.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,207.81 / $1,207.81 / $1,763.81
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,458.65 / $2,458.65 / $7,588.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,136.22 / $1,711.55 / $2,458.65
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,274.37 / $2,501.81 / $3,184.12