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Maine 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
$703.06 / $915.99 / $1,120.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$889.52 / $1,151.15 / $1,607.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$855.37 / $1,298.96 / $1,865.16
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,044.51 / $1,208.50 / $1,853.90
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$703.06 / $1,038.11 / $1,120.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.40 / $1,280.67 / $1,699.50