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New Hampshire rates for HCPCS L4010

Replace Trilateral Socket Brim

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$425.72 / $425.72 / $510.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.16 / $388.00 / $425.72
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$756.07 / $756.07 / $896.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.49 / $460.49 / $482.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$626.01 / $626.01 / $626.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$456.99 / $456.99 / $626.01
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.16 / $612.16 / $1,889.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.82 / $377.20 / $635.51
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$566.27 / $622.90 / $792.78