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New Hampshire rates for HCPCS 67515

Injection Medication/Other Subst Tenon Capsule

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $313.11 / $8,965.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.39 / $88.58 / $115.56
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
$44.96 / $69.00 / $101.67
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$67.44 / $106.08 / $150.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.35 / $89.50 / $181.75
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.93 / $94.33 / $173.74
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
$80.91 / $106.88 / $187.55
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.29 / $54.07 / $64.81