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New Hampshire rates for HCPCS 21151

Reconstruction midface, LeFort II; any direction, requiring bone grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $7,244.36 / $14,791.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,137.96 / $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
$1,548.82 / $3,388.44 / $4,786.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $3,235.94 / $5,495.41
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
$1,819.70 / $2,754.23 / $4,073.80
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
$1,862.09 / $2,818.38 / $5,011.87
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $2,187.76