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New Hampshire rates for HCPCS 67221

Dstrj Lesion Choroid Photodynamic Therapy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $998.00 / $8,965.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.48 / $238.18 / $510.91
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
$199.58 / $306.95 / $444.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.87 / $428.57 / $635.91
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.91 / $473.85 / $951.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,035.00 / $8,035.00 / $8,035.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.31 / $454.99 / $826.54
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.79 / $221.02 / $265.22