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New Hampshire rates for HCPCS L5699

All Lower Extremity Prostheses Shoulder Harness

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$163.01 / $163.01 / $195.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.94 / $126.49 / $168.18
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$289.50 / $289.50 / $343.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.93 / $136.93 / $142.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.96 / $169.96 / $169.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.07 / $124.07 / $169.96
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.40 / $234.40 / $723.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.29 / $144.43 / $171.96
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.83 / $238.51 / $303.56