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Maine 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
$5,623.41 / $5,623.41 / $5,623.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,584.89 / $3,715.35
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,995.26 / $2,951.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,949.84 / $3,090.30
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,862.09 / $3,467.37
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,623.41 / $5,623.41 / $5,623.41
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,737.80 / $3,715.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,778.28 / $2,754.23