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New Hampshire rates for HCPCS L5722

Addition Exoskeletal Knee-Shin System Single Axis Pneumatic Swing Friction Stance Phase Control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$666.86 / $666.86 / $800.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$509.54 / $517.46 / $666.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,184.32 / $1,184.32 / $1,403.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.00 / $659.00 / $691.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.29 / $875.29 / $875.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.96 / $638.96 / $875.29
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$958.89 / $958.89 / $2,959.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.90 / $590.84 / $833.09
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$887.02 / $975.72 / $1,241.83