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New Hampshire rates for HCPCS 25920

Disarticulation Through Wrist

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $1,239.34 / $2,416.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$644.74 / $714.78 / $954.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,669.00 / $20,162.41 / $35,151.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$722.62 / $1,203.91 / $1,847.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.01 / $831.01 / $831.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$902.49 / $1,314.95 / $2,182.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$827.25 / $1,301.43 / $2,553.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,399.00 / $12,399.00 / $12,399.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$814.63 / $1,042.56 / $1,983.63
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$566.48 / $623.13 / $793.07