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New Hampshire rates for HCPCS L5964

Addition Endoskeletal System Above Knee Flexible Protective Outer Surface Covering System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$719.69 / $719.69 / $863.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$558.46 / $564.33 / $719.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,278.16 / $1,278.16 / $1,515.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$682.97 / $682.97 / $717.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.38 / $702.38 / $702.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.74 / $512.74 / $748.77
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,034.85 / $1,034.85 / $3,194.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.10 / $637.66 / $864.14
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$957.30 / $1,053.03 / $1,340.22