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New Hampshire rates for HCPCS L5781

Addition To Lower Limb Prosthesis Vacuum Pump Residual Limb Volume Management And Moisture Evacuation System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,654.56 / $2,654.56 / $3,185.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,059.88 / $2,105.36 / $3,175.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,714.47 / $4,714.47 / $5,588.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,753.59 / $2,902.12 / $2,902.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,886.72 / $2,886.72 / $2,886.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,107.31 / $2,107.31 / $3,077.39
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,817.10 / $3,817.10 / $11,781.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,568.00 / $2,352.00 / $3,374.24
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,530.98 / $3,884.08 / $4,943.37