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New Hampshire rates for HCPCS 20805

Replantation, forearm (includes radius and ulna to radial carpal joint), complete amputation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $9,772.37 / $10,715.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,019.95 / $3,388.44 / $6,606.93
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
$2,884.03 / $6,165.95 / $8,709.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,890.45 / $5,623.41 / $9,772.37
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
$3,388.44 / $5,011.87 / $7,585.78
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
$3,467.37 / $4,897.79 / $8,912.51
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $3,890.45