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New Hampshire rates for HCPCS 15841

Graft for facial nerve paralysis; free muscle graft (including obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $5,963.31 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,192.08 / $1,529.74 / $1,864.14
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
$1,738.95 / $2,650.64 / $4,372.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,472.40 / $2,472.40 / $2,558.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,630.81 / $2,645.72 / $4,527.51
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,990.73 / $3,923.32 / $7,082.82
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
$1,868.27 / $2,741.04 / $7,082.82
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,410.31 / $1,551.34 / $1,974.43