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New Hampshire rates for HCPCS 67250

Scleral Reinforcement Spx W/O Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $2,594.69 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$739.49 / $785.20 / $2,197.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,449.90 / $1,611.00 / $3,700.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$860.09 / $1,352.92 / $2,333.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,114.97 / $1,506.10 / $2,135.66
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,083.08 / $1,768.75 / $3,503.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,565.00 / $9,565.00 / $9,565.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$970.65 / $1,232.14 / $2,471.02
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.93 / $730.32 / $929.50