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New Hampshire rates for HCPCS 21401

Closed Tx Fx Orbit Except Blowout W/Manipulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $1,041.61 / $2,678.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.48 / $451.60 / $643.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,449.90 / $1,611.00 / $3,700.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$332.32 / $546.45 / $806.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$557.65 / $2,000.36 / $2,070.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$451.40 / $747.13 / $1,445.63
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.87 / $749.80 / $1,414.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,611.00 / $8,611.00 / $8,611.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$548.91 / $753.32 / $1,562.34
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.67 / $360.74 / $499.80