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Maryland rates for HCPCS 21142

Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, without bone graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,803.84 / $13,803.84 / $13,803.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,412.54 / $3,715.35
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,584.89 / $1,949.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $512.86 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,698.24 / $3,090.30
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,445.44 / $2,398.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,174.90 / $2,884.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,548.82 / $2,754.23
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,548.82 / $1,995.26