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New Hampshire rates for HCPCS L5654

Addition To Lower Extremity Socket Insert Symes (Kemblo Pelite Aliplast Plastazote Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$298.83 / $298.83 / $358.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.76 / $231.89 / $319.73
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.74 / $530.74 / $629.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.07 / $240.07 / $254.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.16 / $306.16 / $306.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.50 / $223.50 / $326.39
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$429.72 / $429.72 / $1,326.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.52 / $264.77 / $306.01
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.50 / $437.25 / $556.50