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New Hampshire rates for HCPCS 40801

Drg Absc Cst Hmtma Vestibule Mouth Comp

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $779.77 / $6,067.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.66 / $328.65 / $779.77
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,223.09 / $1,359.00 / $3,300.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.44 / $368.18 / $557.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.79 / $511.15 / $847.04
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.20 / $519.32 / $1,014.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,448.00 / $7,448.00 / $7,448.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$406.97 / $616.15 / $1,169.94
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.62 / $247.67 / $337.88