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New Hampshire rates for HCPCS 40761

Plastic repair of cleft lip/nasal deformity; with cross lip pedicle flap (Abbe-Estlander type), including sectioning and inserting of pedicle

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $3,806.83 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.67 / $1,138.23 / $1,178.67
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
$1,056.44 / $1,895.04 / $3,125.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.36 / $2,000.36 / $2,070.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,308.83 / $1,612.91 / $2,878.59
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,209.40 / $2,383.46 / $4,302.92
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
$1,210.30 / $1,614.47 / $6,043.98
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$860.30 / $946.33 / $1,204.42