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New Hampshire rates for HCPCS 12021

Tx Superficial Wound Dehiscence W/Packing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$249.75 / $551.72 / $2,331.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.37 / $136.31 / $173.10
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,223.09 / $1,359.00 / $3,300.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.47 / $213.07 / $331.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,306.21 / $1,306.21 / $1,351.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.37 / $304.70 / $540.72
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.32 / $348.60 / $559.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,448.00 / $7,448.00 / $7,448.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.41 / $279.23 / $602.77
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.63 / $148.69 / $203.91