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New Hampshire rates for HCPCS L5974

All lower extremity prostheses, foot, single axis ankle/foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $204.17 / $245.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $177.83 / $316.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $398.11 / $457.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $169.82 / $177.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $173.78 / $269.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $173.78
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $562.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $190.55 / $229.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $194.98 / $316.23
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $323.59 / $524.81