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New Hampshire rates for HCPCS 21172

Reconstruction superior-lateral orbital rim and lower forehead, advancement or alteration, with or without grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $6,309.57 / $15,848.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,344.23 / $4,168.69
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
$2,089.30 / $4,073.80 / $5,754.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $3,162.28 / $6,456.54
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
$2,454.71 / $3,630.78 / $5,495.41
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
$2,187.76 / $3,162.28 / $5,888.44
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,584.89 / $2,511.89