The statewide reports identify the range of provider charges and insurer prices for the most common procedures in New Hampshire. These reports were created using data submitted by insurance carriers to the New Hampshire Comprehensive Health Care Information System (CHIS). The data and reports are developed for users familiar with claims data limitations and the information has not been reviewed for accuracy by the Department.
Prices are determined based on the "allowed amount" and include payments due from the insurance company as well as any patient cost sharing (deductible, coinsurance, copayments). The data in the tables are reported using CPT (Current Procedural Terminology) codes, separated by professional and institutional provider payments.
Important Information about Statewide Report
There are two tables provided:
- Statewide Summary. This table includes data for all carriers and insurer commercial products, but separates insurance into group and individual.
- By Carrier and insurance type. This table provides charge and price ranges by carrier, with commercial products consolidated.
- The tables include charge and price values at the 25th percentile, the median (or 50th percentile), and the 75th percentile. These ranges were selected to minimize the influence of outlier cases on the data reported.
For each report, the following filters were applied to the data:
- Rates are provided when the data have at least 3 observations for a procedure code, carrier, and insurance type;
- Outpatient and professional office claims;
- Claims from providers located in New Hampshire;
- Carriers included are Ambetter, Anthem, Cigna, Harvard Pilgrim (HPHC), Tufts, Other (mix of all other carriers)
- Estimates provided in the report are calculated based on one unit of service. Previous iterations of the Statewide Report did not include claims where there was more than one unit of service. In doing so, a significant number of anesthesia, ambulance, and drugs administration claims were excluded. These types of services often involve claims with more than one unit of service.
- Units are obtained from the claim submitted, and have not been tested for accuracy.
- Units may reflect different values depending on type of service (e.g. ambulance unit = 1 mile, anesthesia unit = 15 minutes).
- When a claim involves more than one unit of service, the price and charge are adjusted to a per unit of service for each claim before computing the descriptive statistics in the report.
- Charges and prices for procedures are identified separately for claims with modifiers 26 (professional component), TC (technical component), NU (new equipment), and RR (rental equipment).
- Codes that do not list a modifier reflect the charge and price for all claims that reported no modifiers or other modifiers not noted above.
- Charges and prices are identified separately for professional (i.e. office based) claims and hospital claims.