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New Hampshire rates for HCPCS L5920

Addition Endoskeletal System Above Knee Or Hip Disarticulation Alignable System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.11 / $478.11 / $573.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.39 / $371.00 / $478.57
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$594.38 / $594.38 / $594.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$849.12 / $849.12 / $1,006.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.54 / $386.54 / $406.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$397.94 / $397.94 / $397.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.50 / $290.50 / $424.22
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$687.50 / $687.50 / $2,121.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.70 / $454.65 / $687.50
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.97 / $699.57 / $890.36