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New Hampshire rates for HCPCS 28805

Amputation, foot; transmetatarsal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $2,754.23 / $11,481.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $4,677.35 / $6,309.57
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $9,549.93 / $9,549.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $9,549.93 / $9,549.93
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $524.81 / $831.76
Well Sense
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$776.25 / $776.25 / $776.25