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New Hampshire rates for HCPCS L5694

Addition To Lower Extremity Above Knee Pelvic Control Belt Padded And Lined

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$163.47 / $163.47 / $196.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.24 / $126.85 / $163.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.32 / $290.32 / $344.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.08 / $132.08 / $138.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.85 / $140.85 / $140.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.82 / $102.82 / $140.85
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.06 / $235.06 / $725.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.63 / $144.84 / $244.04
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.44 / $239.18 / $304.42