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New Hampshire rates for HCPCS 21083

Impression and custom preparation; palatal lift prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,365.16 / $4,365.16 / $5,248.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,513.56 / $2,454.71
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,737.80 / $3,019.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,778.28 / $2,511.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,187.76 / $4,073.80
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,220.18 / $11,220.18 / $11,220.18
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,905.46 / $3,311.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,220.18 / $11,220.18 / $11,220.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,949.84 / $3,388.44
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,621.81