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New Hampshire rates for HCPCS L5975

All lower extremity prostheses, combination single axis ankle and flexible keel foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $309.03 / $371.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $275.42 / $457.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $588.84 / $676.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $302.00 / $302.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $363.08 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $263.03 / $363.08
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $478.63 / $831.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $338.84 / $371.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $295.12 / $478.63
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $776.25