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Maine rates for HCPCS 21145

Reconstruction midface, LeFort I; single piece, segment movement in any direction, requiring bone grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,778.28 / $4,168.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,238.72 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,187.76 / $3,467.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,089.30 / $3,890.45
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,995.26 / $4,265.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $2,041.74 / $3,090.30