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New Hampshire rates for HCPCS 15572

Formation of direct or tubed pedicle, with or without transfer; scalp, arms, or legs

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,310.65 / $2,545.48 / $2,991.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.23 / $711.15 / $948.91
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
$722.62 / $1,094.08 / $1,677.06
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
$798.71 / $1,310.07 / $2,224.03
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$929.59 / $1,776.06 / $2,943.27
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
$927.97 / $1,554.12 / $3,105.37
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$615.70 / $781.92 / $1,106.10