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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
$205.31 / $205.31 / $246.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.32 / $159.38 / $228.91
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$364.64 / $364.64 / $432.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.68 / $170.68 / $178.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$174.77 / $174.77 / $174.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.58 / $127.58 / $186.32
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.23 / $295.23 / $911.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.28 / $181.91 / $215.99
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.10 / $300.41 / $382.34