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Maryland rates for HCPCS 21123

Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$784.65 / $878.65 / $1,021.34
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$938.65 / $938.65 / $1,192.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$990.00 / $1,012.17 / $1,316.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$782.11 / $1,122.50 / $2,070.40
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.91 / $1,123.47 / $1,482.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$475.00 / $520.00 / $832.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$681.01 / $957.17 / $1,775.48
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$797.85 / $1,001.55 / $1,244.57