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New Hampshire rates for HCPCS L5971

All lower extremity prostheses, solid ankle cushion heel (SACH) foot, replacement only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$183.01 / $183.01 / $219.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.67 / $142.00 / $183.01
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$325.01 / $325.01 / $385.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.22 / $148.22 / $155.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.21 / $159.21 / $159.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.22 / $116.22 / $159.21
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.14 / $263.14 / $812.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.10 / $162.13 / $192.53
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.42 / $267.76 / $340.79