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Washington, DC rates for HCPCS 21049

Excision of benign tumor or cyst of maxilla; requiring extra-oral osteotomy and partial maxillectomy (eg, locally aggressive or destructive lesion[s])

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,179.53 / $1,179.53 / $1,179.53
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,273.92 / $1,309.07 / $8,500.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,157.39 / $2,037.83 / $3,346.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,253.81 / $2,595.98 / $2,595.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,003.05 / $1,579.99 / $3,143.03