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New Hampshire rates for HCPCS 21175

Rcnstj Bifrontal Superior-Lat Orb Rims & Lwr Fhd

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $3,668.46 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,997.11 / $2,175.55 / $3,415.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,769.10 / $5,299.00 / $8,600.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,148.78 / $3,579.94 / $5,492.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,486.26 / $2,486.26 / $2,486.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,805.29 / $4,152.91 / $6,488.09
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,459.90 / $4,035.71 / $7,592.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,155.00 / $11,155.00 / $11,155.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,510.39 / $3,419.35 / $6,711.94
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,757.20 / $1,932.92 / $2,460.08