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New Hampshire rates for HCPCS 25690

Closed treatment of lunate dislocation, with manipulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $1,819.70 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $537.03 / $1,000.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,737.80 / $3,019.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $977.24 / $1,348.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $794.33 / $1,513.56
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $8,709.64 / $8,709.64
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $831.76 / $1,258.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $8,709.64 / $8,709.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $776.25 / $1,445.44
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $380.19 / $602.56