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New Hampshire rates for HCPCS 25924

Disarticulation Thru Wrist Re-Amputation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $1,209.58 / $2,359.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$623.84 / $653.22 / $932.95
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
$705.15 / $1,174.81 / $1,802.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$810.92 / $810.92 / $810.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$881.77 / $1,284.68 / $2,131.77
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$807.25 / $1,269.97 / $2,491.58
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
$807.25 / $1,032.08 / $1,935.56
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.79 / $608.08 / $773.92