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New Hampshire rates for HCPCS L5976

All lower extremity prostheses, energy storing foot (Seattle Carbon Copy II or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$464.36 / $464.36 / $557.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.17 / $369.10 / $548.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$824.70 / $824.70 / $977.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.90 / $409.90 / $428.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$420.01 / $420.01 / $420.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.61 / $306.61 / $447.75
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$667.72 / $667.72 / $2,060.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.29 / $411.43 / $505.14
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$617.66 / $679.43 / $864.72