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New Hampshire rates for HCPCS L5968

Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,410.92 / $2,410.92 / $2,893.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,870.82 / $1,912.12 / $2,883.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,281.77 / $4,281.77 / $5,075.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.84 / $2,635.75 / $2,635.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,448.80 / $2,448.80 / $2,448.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,787.62 / $1,787.62 / $2,871.59
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,466.77 / $3,466.77 / $10,700.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,424.09 / $2,136.13 / $3,064.55
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,206.90 / $3,527.59 / $4,489.66