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Maine rates for HCPCS 21142

Rcnstj Midface Lefort I 2 Pieces W/O Bone Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,602.52 / $5,602.52 / $5,602.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,171.19 / $1,354.14 / $1,756.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,424.99 / $1,844.10 / $2,594.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,379.96 / $2,102.42 / $2,983.40
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,694.55 / $1,960.59 / $3,007.66
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,602.52 / $5,602.52 / $5,602.52
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,171.19 / $1,378.56 / $1,756.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,347.20 / $1,977.77 / $2,636.72