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New Hampshire rates for HCPCS L5972

All Lower Extremity Prostheses Foot Flexible Keel (Revised 01012013)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$277.64 / $277.64 / $333.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.90 / $215.45 / $332.10
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.82 / $369.82 / $369.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$493.09 / $493.09 / $584.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.94 / $272.08 / $272.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.77 / $293.77 / $293.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.45 / $214.45 / $313.17
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$399.24 / $399.24 / $1,232.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.00 / $246.00 / $317.89
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.31 / $406.24 / $517.03