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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
$1,203.63 / $1,203.63 / $1,444.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$934.00 / $954.62 / $1,203.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.66 / $2,137.66 / $2,533.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,248.52 / $1,315.88 / $1,315.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,222.54 / $1,222.54 / $1,222.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$892.45 / $892.45 / $1,222.54
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.77 / $1,730.77 / $5,342.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$710.97 / $1,066.46 / $1,504.11
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,601.04 / $1,761.14 / $2,241.46