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New Hampshire rates for HCPCS L5855

Addition Endoskeletal System Hip Disarticulation Mechanical Hip Extension Assist

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.71 / $208.71 / $250.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.94 / $165.53 / $222.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$370.68 / $370.68 / $439.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.02 / $224.02 / $236.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.78 / $239.78 / $239.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.04 / $175.04 / $246.97
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.12 / $300.12 / $926.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$247.02 / $247.02 / $247.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.28 / $184.93 / $265.30
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.62 / $305.38 / $388.67