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New Hampshire rates for HCPCS 21123

Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $2,331.21 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$730.44 / $963.08 / $1,120.27
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
$819.66 / $1,405.57 / $2,095.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$943.02 / $3,906.58 / $4,043.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,079.00 / $1,608.87 / $2,520.86
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$938.34 / $1,539.44 / $2,896.19
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
$969.51 / $1,362.94 / $2,429.06
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$696.70 / $766.37 / $975.38