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New Hampshire rates for HCPCS L3265

Plastazote sandal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.47 / $10.47 / $12.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $8.91 / $12.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $26.92 / $27.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.84 / $28.84 / $28.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $28.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $52.48 / $93.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.50 / $8.71 / $35.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.61 / $9.55 / $52.48