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New Hampshire rates for HCPCS L5685

Addition To Lower Extremity Prosthesis Below Kneesuspension/Sealing Sleeve

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.98 / $84.98 / $101.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.94 / $67.40 / $101.65
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.19 / $113.19 / $113.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.91 / $150.91 / $178.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.15 / $92.90 / $92.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.03 / $100.03 / $100.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.02 / $73.02 / $100.03
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.20 / $122.20 / $377.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.20 / $75.29 / $106.19
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.04 / $124.34 / $158.26