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New Hampshire rates for HCPCS L5979

All lower extremity prostheses, multiaxial ankle, dynamic response foot, one-piece system

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,600.69 / $1,600.69 / $1,920.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,242.08 / $1,255.16 / $1,914.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,842.81 / $2,842.81 / $3,369.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,660.84 / $1,660.84 / $1,747.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,711.28 / $1,711.28 / $1,711.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,249.23 / $1,249.23 / $1,824.31
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,301.69 / $2,301.69 / $7,104.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,110.47 / $1,683.99 / $2,301.69
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,129.17 / $2,342.09 / $2,980.84