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Maryland rates for HCPCS 21120

Genioplasty; augmentation (autograft, allograft, prosthetic material)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,687.02 / $3,687.02 / $3,687.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$471.61 / $595.84 / $754.99
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$582.34 / $607.49 / $771.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$641.21 / $990.00 / $2,754.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$490.73 / $737.39 / $1,464.65
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$689.47 / $889.42 / $1,204.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$520.00 / $520.00 / $733.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.78 / $740.62 / $1,307.57
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.24 / $792.89 / $975.62