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New Hampshire rates for HCPCS 21245

Rcnstj Mndbl/Maxl Subpriosteal Implant Partial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $3,265.28 / $5,229.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$819.18 / $1,067.84 / $1,502.88
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
$931.31 / $1,528.40 / $2,071.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.46 / $3,906.58 / $4,043.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,293.52 / $1,993.38 / $3,453.39
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,150.40 / $1,984.00 / $3,749.56
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
$1,386.02 / $1,853.03 / $3,565.80
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$739.34 / $964.54 / $1,157.45