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New Hampshire rates for HCPCS L5705

Custom Shaped Protective Cover Above Knee

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$736.13 / $736.13 / $883.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$544.66 / $577.24 / $865.56
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$915.16 / $915.16 / $915.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,307.36 / $1,307.36 / $1,549.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$686.95 / $686.95 / $711.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$895.43 / $895.43 / $895.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$653.66 / $653.66 / $954.57
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,058.53 / $1,058.53 / $3,267.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.82 / $652.24 / $857.13
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$979.18 / $1,077.09 / $1,370.85