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New Hampshire rates for HCPCS 26502

Reconstruction of tendon pulley, each tendon; with tendon or fascial graft (includes obtaining graft) (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $2,454.71 / $14,791.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $812.83 / $1,548.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $4,677.35 / $6,309.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,445.44 / $2,041.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $2,570.40 / $2,570.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,288.25 / $2,344.23
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $10,000.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,288.25 / $1,949.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,174.90 / $2,187.76
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $588.84 / $933.25