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New Hampshire rates for HCPCS 14021

Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq cm to 30.0 sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $2,754.23 / $11,481.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $758.58 / $2,041.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,737.80 / $3,019.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $1,096.48 / $1,659.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,174.90 / $2,137.96
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $8,709.64 / $8,709.64
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,318.26 / $2,344.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $8,709.64 / $8,709.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,230.27 / $2,454.71
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $912.01 / $1,122.02