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Maryland rates for HCPCS 21143

Rcnstj Midface Lefort I 3/> Piece W/O Bone Graft

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,278.50 / $1,454.06 / $3,706.81
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,560.00 / $1,714.63 / $1,886.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.00 / $507.00 / $641.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,268.50 / $1,860.94 / $3,231.40
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,453.92 / $1,875.56 / $2,464.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$847.00 / $847.00 / $1,560.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,123.46 / $1,631.91 / $2,941.43
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,299.79 / $1,672.01 / $2,080.13