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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
$2,398.83 / $7,943.28 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,570.40 / $4,897.79
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
$2,187.76 / $4,570.88 / $6,456.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,754.23 / $3,715.35 / $7,413.10
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
$2,570.40 / $3,801.89 / $5,754.40
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
$2,570.40 / $3,630.78 / $6,918.31
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $2,884.03