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New Hampshire rates for HCPCS L5679

Addition To Lower Extremity Below Knee/Above Kneecustom Fabricated Fromexisting Mold Or Prefabric Ated Socket Insert Silicone Gel Elastomeric Or Equal Not For Use With Locking Mechanism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.29 / $444.29 / $533.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.80 / $344.75 / $531.41
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591.78 / $591.78 / $591.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$789.04 / $789.04 / $935.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$424.98 / $424.98 / $426.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$440.05 / $440.05 / $440.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.24 / $321.24 / $516.02
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.85 / $638.85 / $1,971.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.43 / $393.64 / $502.25
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$590.96 / $650.05 / $827.34