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New Hampshire rates for HCPCS L5857

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,888.44 / $5,888.44 / $7,079.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,466.84 / $5,128.61 / $8,511.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,471.29 / $11,220.18 / $12,882.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,623.41 / $5,623.41 / $5,623.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $6,606.93 / $6,606.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $4,897.79 / $6,606.93
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,120.11 / $9,120.11 / $15,848.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $6,309.57 / $6,918.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,073.80 / $5,495.41 / $9,120.11
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,332.54 / $9,332.54 / $14,791.08