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New Hampshire rates for HCPCS L5930

Addition Endoskeletal System High Activity Knee Control Frame

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,345.81 / $2,345.81 / $2,814.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,771.11 / $1,820.29 / $2,805.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,166.12 / $4,166.12 / $4,938.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,207.84 / $2,207.84 / $2,331.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,282.71 / $2,282.71 / $2,282.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,666.39 / $1,666.39 / $2,282.71
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,373.12 / $3,373.12 / $10,411.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,982.23 / $1,982.23 / $1,982.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,385.62 / $2,078.42 / $3,319.45
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,120.28 / $3,432.31 / $4,368.39