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New Hampshire rates for HCPCS 21125

Augmentation, mandibular body or angle; prosthetic material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $2,666.51 / $10,965.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$677.66 / $2,286.89 / $3,673.26
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
$664.64 / $1,129.88 / $1,802.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,144.52 / $3,906.58 / $4,043.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$947.41 / $3,068.99 / $7,874.41
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$823.39 / $2,683.72 / $7,004.70
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
$3,023.62 / $4,384.25 / $8,068.55
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$545.57 / $763.80 / $2,776.63