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New Hampshire rates for HCPCS 21267

Orbital Repositioning W/Bone Grafts Extracranial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $2,676.48 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,499.24 / $1,570.68 / $2,077.01
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
$1,560.72 / $2,676.35 / $3,989.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,794.83 / $3,906.58 / $4,043.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,046.72 / $3,031.49 / $4,736.08
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,786.70 / $2,931.26 / $5,514.65
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
$1,783.00 / $2,385.27 / $4,574.47
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,291.82 / $1,421.00 / $1,808.55