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New Hampshire rates for HCPCS L5962

Addition, endoskeletal system, below knee (BK), flexible protective outer surface covering system

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $478.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $398.11 / $794.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $776.25 / $870.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $467.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $446.68 / $512.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $331.13 / $446.68
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $616.60 / $1,071.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $478.63 / $524.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $380.19 / $616.60
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $630.96 / $1,000.00