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New Hampshire rates for HCPCS K0195

Elevating Leg Rests Pair (For Use With Capped Rental Wheelchair Base) (Special Coverage Instructions Apply. See Cim: 60-9)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.59 / $84.29 / $90.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.45 / $104.45 / $104.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.70 / $88.70 / $98.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.41 / $75.40 / $88.70
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.80 / $285.76 / $362.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.91 / $8.77 / $81.05
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.09 / $154.11 / $196.14