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New Hampshire rates for HCPCS 21143

Rcnstj Midface Lefort I 3/> Piece W/O Bone Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $2,353.73 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,350.18 / $1,457.49 / $1,824.11
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
$1,370.52 / $2,350.19 / $3,503.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,579.28 / $1,579.28 / $1,579.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,799.92 / $2,660.82 / $4,156.97
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,568.96 / $2,468.29 / $4,842.60
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
$1,608.38 / $2,186.73 / $4,004.35
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,129.58 / $1,355.51 / $1,992.60