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New Hampshire rates for HCPCS 20802

Replantation, arm (includes surgical neck of humerus through elbow joint), complete amputation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $8,709.64 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $2,818.38 / $5,495.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,912.51 / $10,000.00 / $18,197.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $5,248.07 / $7,413.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.30 / $4,265.80 / $8,317.64
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,589.25 / $12,589.25 / $12,589.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.03 / $4,265.80 / $6,309.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,589.25 / $12,589.25 / $12,589.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.03 / $4,073.80 / $7,413.10
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $2,041.74 / $3,235.94