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New Hampshire rates for HCPCS L2630

Addition to lower extremity, pelvic control, band and belt, unilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.75 / $194.75 / $233.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.81 / $151.12 / $209.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$345.90 / $345.90 / $410.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.99 / $169.99 / $178.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$174.32 / $174.32 / $174.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.25 / $127.25 / $185.83
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.05 / $280.05 / $864.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.04 / $172.56 / $204.88
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.05 / $284.95 / $362.67