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New Hampshire rates for HCPCS L5987

All Lower Extremity Prosthesis Shank Foot System With Vertical Loading Pylon

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,772.64 / $4,772.64 / $5,727.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,703.46 / $3,785.25 / $5,708.70
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,357.14 / $6,357.14 / $6,357.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,476.18 / $8,476.18 / $10,047.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,950.71 / $5,217.74 / $5,217.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,042.00 / $6,042.00 / $6,042.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,410.66 / $4,410.66 / $6,229.90
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,862.77 / $6,862.77 / $21,181.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,819.11 / $4,228.67 / $5,922.73
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,348.37 / $6,983.21 / $8,887.71