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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
$12,330.30 / $12,330.30 / $14,796.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,568.04 / $9,779.29 / $12,330.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,898.50 / $21,898.50 / $25,958.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,489.26 / $12,489.26 / $12,790.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,513.81 / $14,513.81 / $14,513.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $10,595.08 / $14,513.81
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,730.22 / $17,730.22 / $54,724.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,283.28 / $10,924.91 / $18,406.70