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New Hampshire rates for HCPCS L5670

Addition to lower extremity, below knee (BK), molded supracondylar suspension (PTS or similar)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.78 / $194.78 / $233.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.13 / $165.76 / $232.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$345.93 / $345.93 / $410.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.18 / $197.18 / $207.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.51 / $203.51 / $203.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.56 / $148.56 / $216.96
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.08 / $280.08 / $864.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.05 / $172.58 / $280.08
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.08 / $284.99 / $362.71