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New Hampshire rates for HCPCS 21193

Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; without bone graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $2,331.21 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,093.65 / $1,246.43 / $1,588.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,769.10 / $5,299.00 / $8,600.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,197.47 / $1,995.02 / $3,060.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,381.30 / $1,381.30 / $1,381.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,578.03 / $2,323.06 / $3,691.78
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,370.85 / $2,249.02 / $4,231.13
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
$1,370.85 / $1,904.18 / $3,737.78
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$982.78 / $1,081.06 / $1,375.89