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New Hampshire rates for HCPCS L3254

Non-Standard Size Or Width (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.61 / $28.61 / $34.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.05 / $15.00 / $28.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.38 / $65.38 / $65.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.75 / $10.75 / $10.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.85 / $7.85 / $10.75
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $52.94 / $163.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $52.94 / $52.94