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New Hampshire rates for HCPCS L5988

Addition to lower limb prosthesis, vertical shock reducing pylon feature

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,325.38 / $1,325.38 / $1,590.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,028.46 / $1,051.17 / $1,585.32
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,353.86 / $2,353.86 / $2,790.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,374.81 / $1,448.96 / $1,448.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,346.19 / $1,346.19 / $1,346.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$982.72 / $982.72 / $1,435.11
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.81 / $1,905.81 / $5,882.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$782.88 / $1,174.31 / $1,644.74
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,762.96 / $1,939.26 / $2,468.14