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New Hampshire rates for HCPCS 65130

Insertion of ocular implant secondary; after evisceration, in scleral shell

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $2,754.23 / $11,481.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $870.96 / $1,230.27
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
$758.58 / $1,513.56 / $2,344.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,479.11 / $2,511.89
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
$912.01 / $1,479.11 / $2,511.89
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
$891.25 / $1,230.27 / $2,454.71