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New Hampshire rates for HCPCS 14021

Adjt/Rearrgmt Scalp/Arm/Leg 10.1-30.0 Sq Cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,263.08 / $2,610.76 / $3,081.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$631.54 / $755.77 / $964.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,449.90 / $1,611.00 / $3,700.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$694.80 / $1,066.20 / $1,652.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.36 / $2,000.36 / $2,070.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$784.96 / $1,289.04 / $2,156.81
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$906.28 / $1,750.12 / $2,829.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,611.00 / $8,611.00 / $8,611.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$844.36 / $1,335.24 / $3,466.32
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$614.48 / $758.99 / $1,026.61