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New Hampshire rates for HCPCS 21147

Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted bilateral alveolar cleft or multiple osteotomies)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $2,836.52 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,666.03 / $1,798.14 / $2,198.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,299.00 / $16,696.31 / $29,108.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,653.23 / $2,814.24 / $4,225.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,910.77 / $1,910.77 / $1,910.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,142.52 / $3,212.37 / $5,018.68
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,892.60 / $2,977.44 / $5,841.51
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
$1,882.60 / $2,695.06 / $4,192.10
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,356.33 / $1,491.96 / $1,898.86