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New Hampshire rates for HCPCS 21146

Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted unilateral alveolar cleft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $5,888.44 / $14,791.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,862.09 / $3,715.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $5,623.41 / $8,912.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $3,090.30 / $4,365.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,884.03 / $4,897.79
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,220.18 / $11,220.18 / $11,220.18
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,511.89 / $3,801.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,220.18 / $11,220.18 / $11,220.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,398.83 / $4,365.16
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $1,949.84