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New Hampshire rates for HCPCS 21725

Division Sternocleidomastoid Open W/Cast

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $1,876.78 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$499.17 / $557.03 / $708.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,223.09 / $1,359.00 / $3,300.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$539.86 / $908.15 / $1,379.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$620.84 / $2,000.36 / $2,070.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.00 / $1,033.01 / $1,613.87
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$618.03 / $1,013.94 / $1,907.55
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,035.00 / $8,035.00 / $8,035.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.36 / $809.78 / $1,630.25
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$428.09 / $470.90 / $599.33