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New Hampshire rates for HCPCS L5920

Addition, endoskeletal system, above knee (AK) or hip disarticulation, alignable system

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $478.63 / $575.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $407.38 / $616.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $933.25 / $1,047.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $389.05 / $398.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $630.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $288.40 / $398.11
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $1,288.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $416.87 / $478.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $457.09 / $741.31
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $1,202.26