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New Hampshire rates for HCPCS L5975

All Lower Extremity Prosthesis Combination Single Axis Ankle And Flexible Keel Foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$307.57 / $307.57 / $369.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.66 / $243.93 / $367.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$546.23 / $546.23 / $647.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.45 / $305.45 / $319.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.03 / $362.03 / $362.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.27 / $264.27 / $385.94
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$442.26 / $442.26 / $1,365.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.67 / $272.51 / $384.36
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.11 / $450.02 / $572.75