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New Hampshire rates for HCPCS L5858

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,302.69 / $12,302.69 / $14,791.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,549.93 / $11,220.18 / $18,620.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22,387.21 / $23,988.33 / $26,915.35
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,589.25 / $12,589.25 / $12,589.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,454.40 / $14,454.40 / $14,454.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,715.19 / $10,715.19 / $14,454.40
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19,054.61 / $19,054.61 / $33,113.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,165.95 / $13,803.84 / $15,135.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,511.38 / $11,748.98 / $19,054.61
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,498.45 / $19,498.45 / $31,622.78