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New Hampshire rates for HCPCS L5684

Addition to lower extremity, below knee, fork strap

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.74 / $40.74 / $48.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $34.67 / $64.57
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $79.43 / $89.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $35.48 / $36.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $37.15 / $53.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $27.54 / $37.15
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $63.10 / $109.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.78 / $39.81 / $61.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $38.90 / $63.10
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $104.71