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New Hampshire rates for HCPCS L5856

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,108.10 / $16,108.10 / $19,329.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,499.54 / $12,631.57 / $19,267.39
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28,607.84 / $28,607.84 / $33,911.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,544.62 / $17,411.83 / $17,411.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,200.25 / $16,200.25 / $16,200.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,826.18 / $11,826.18 / $16,200.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23,162.50 / $23,162.50 / $71,491.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,514.76 / $14,272.14 / $19,931.41