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New Hampshire rates for HCPCS L5626

Addition To Lower Extremity Test Socket Hip Disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$390.14 / $390.14 / $468.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.04 / $305.20 / $439.79
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$692.87 / $692.87 / $821.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.85 / $345.85 / $365.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$493.58 / $493.58 / $493.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.31 / $360.31 / $509.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$560.98 / $560.98 / $1,731.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.44 / $345.67 / $436.88
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$518.94 / $570.83 / $726.52