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New Hampshire rates for HCPCS L5990

Addition to lower extremity prosthesis, user adjustable heel height

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,202.26 / $1,445.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,071.52 / $1,778.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $2,344.23 / $2,630.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,318.26 / $1,348.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $1,584.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $1,230.27
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $3,235.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $1,348.96 / $1,479.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,148.15 / $1,862.09
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $1,905.46 / $3,090.30