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New Hampshire rates for HCPCS 21141

Rcnstj Midface Lefort I 1 Piece W/O Bone Graft

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
$1,207.86 / $1,380.34 / $1,712.31
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
$1,295.80 / $2,222.05 / $3,312.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,491.55 / $1,491.55 / $1,491.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,702.46 / $2,518.08 / $3,934.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,483.42 / $2,333.71 / $4,578.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,155.00 / $11,155.00 / $11,155.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,545.87 / $2,260.59 / $4,021.38
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,058.54 / $1,270.25 / $1,867.26