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New Hampshire rates for HCPCS 21275

Secondary revision of orbitocraniofacial reconstruction

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $2,884.03 / $22,387.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $954.99 / $1,737.80
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
$758.58 / $1,621.81 / $2,290.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $4,073.80 / $4,073.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,380.38 / $2,570.40
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
$891.25 / $1,318.26 / $1,995.26
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
$912.01 / $1,288.25 / $2,398.83
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $630.96 / $1,023.29