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New Hampshire rates for HCPCS 21261

Periorbital osteotomies for orbital hypertelorism, with bone grafts; combined intra- and extracranial approach

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $4,044.23 / $8,025.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,898.38 / $2,192.17 / $3,160.67
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
$2,363.56 / $3,937.78 / $6,041.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,718.09 / $2,718.09 / $2,718.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,939.93 / $4,574.88 / $7,147.32
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,705.78 / $4,439.10 / $8,351.39
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
$2,695.02 / $3,771.96 / $6,872.82
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,950.74 / $2,145.81 / $2,731.04