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Maine rates for HCPCS 21151

Reconstruction midface, LeFort II; any direction, requiring bone grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,089.30 / $4,677.35
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $2,630.27 / $4,265.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,630.27 / $3,981.07
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,344.23 / $4,365.16
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,511.89 / $5,754.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,398.83 / $3,715.35