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New Hampshire rates for HCPCS 21120

Genioplasty; augmentation (autograft, allograft, prosthetic material)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $1,761.34 / $5,229.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$456.34 / $605.61 / $842.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,769.10 / $5,299.00 / $8,600.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$502.02 / $825.60 / $1,192.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$838.97 / $3,906.58 / $4,043.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$715.56 / $1,077.54 / $1,876.88
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.26 / $1,079.27 / $2,018.40
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
$769.57 / $998.45 / $1,966.72
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$418.51 / $540.53 / $648.64