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Maine rates for HCPCS 21120

Genioplasty; augmentation (autograft, allograft, prosthetic material)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$456.34 / $664.33 / $854.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$579.97 / $661.52 / $973.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$631.91 / $950.72 / $1,389.31
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$631.49 / $818.22 / $1,452.26
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$522.12 / $654.04 / $854.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.15 / $881.85 / $1,343.18