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New Hampshire rates for HCPCS L5698

Addition To Lower Extremity Above Knee Or Knee Disarticulation Silesian Bandage

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.20 / $81.20 / $97.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.32 / $68.41 / $97.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.21 / $144.21 / $170.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.13 / $76.13 / $79.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.25 / $99.25 / $99.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.45 / $72.45 / $99.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.76 / $116.76 / $360.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.50 / $82.54 / $93.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.96 / $71.94 / $96.89
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.01 / $118.81 / $151.21