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New Hampshire rates for HCPCS L5701

Replacement Socket Above Knee/Knee Disarticulation Including Attachment Plate Molded To Patient Model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,443.04 / $2,443.04 / $2,931.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,895.75 / $1,915.68 / $2,922.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,338.82 / $4,338.82 / $5,143.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,469.21 / $2,469.21 / $2,604.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,550.04 / $2,550.04 / $2,550.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,861.53 / $1,861.53 / $2,990.32
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,512.95 / $3,512.95 / $10,842.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,443.06 / $2,164.59 / $3,063.81
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,249.63 / $3,574.59 / $4,549.47