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New Hampshire rates for HCPCS L3250

Orthopedic Footwear Custom Molded Shoe Removable Inner Mold Prosthetic Shoe Each (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.86 / $170.86 / $205.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.08 / $150.72 / $170.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.74 / $183.74 / $183.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.68 / $210.68 / $210.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.80 / $153.80 / $210.68
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.32 / $235.32 / $726.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $148.69 / $290.69
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.81 / $422.19 / $537.33