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New Hampshire rates for HCPCS 40701

Plstc Rpr Cl Lip/Nsl Dfrm Prim Bi 1 Stg Px

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $4,121.39 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.67 / $1,171.22 / $1,255.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,769.10 / $5,299.00 / $8,600.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,165.44 / $2,081.13 / $3,448.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,906.58 / $3,906.58 / $4,043.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,359.45 / $1,780.71 / $3,177.12
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,334.19 / $2,629.42 / $4,746.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,155.00 / $11,155.00 / $11,155.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,334.19 / $1,840.66 / $6,658.09
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$947.40 / $1,136.88 / $1,794.38