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New Hampshire rates for HCPCS L5704

Custom Shaped Protective Cover Below Knee

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$401.54 / $401.54 / $481.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.58 / $314.85 / $480.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$713.13 / $713.13 / $845.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.00 / $384.00 / $403.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.91 / $394.91 / $394.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.27 / $288.27 / $420.99
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$577.38 / $577.38 / $1,782.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.18 / $355.77 / $474.94
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$534.11 / $587.52 / $747.75