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New Hampshire rates for HCPCS 21180

Reconstruction, entire or majority of forehead and/or supraorbital rims; with autograft (includes obtaining grafts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $6,025.60 / $15,848.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,905.46 / $4,466.84
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
$1,479.11 / $3,235.94 / $4,570.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,754.23 / $5,128.61
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
$1,778.28 / $2,570.40 / $3,890.45
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
$1,819.70 / $2,511.89 / $4,677.35
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $2,041.74