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New Hampshire rates for HCPCS 15120

Split Agrft F/S/N/H/F/G/M/D Gt 1st 100 Cm/</1 %

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,223.96 / $2,760.13 / $3,285.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$626.62 / $711.60 / $981.45
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,302.10 / $3,669.21 / $6,000.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$675.39 / $1,034.30 / $1,600.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,751.69 / $1,751.69 / $1,812.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$749.34 / $1,251.60 / $2,102.19
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$880.97 / $1,694.90 / $2,750.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,949.00 / $9,949.00 / $9,949.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$868.64 / $1,386.34 / $2,983.76
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.64 / $764.46 / $1,034.20