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Maine rates for HCPCS 21146

Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted unilateral alveolar cleft)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,862.09 / $4,365.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $2,344.23 / $3,467.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,290.87 / $3,630.78
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,137.96 / $4,073.80
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,137.96 / $4,570.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $2,089.30 / $3,235.94