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New Hampshire rates for HCPCS 25316

Flexor origin slide (eg, for cerebral palsy, Volkmann contracture), forearm and/or wrist; with tendon(s) transfer

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $3,388.44 / $11,481.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,023.29 / $1,862.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,912.51 / $10,000.00 / $18,197.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,778.28 / $2,511.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,698.24 / $2,818.38
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,302.69 / $12,302.69 / $12,302.69
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,513.56 / $2,238.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,302.69 / $12,302.69 / $12,302.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,479.11 / $2,630.27
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $691.83 / $1,096.48