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Maryland rates for HCPCS 21160

Reconstruction midface, LeFort III (extra and intracranial) with forehead advancement (eg, mono bloc), requiring bone grafts (includes obtaining autografts); with LeFort I

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,510.29 / $2,882.12 / $3,267.82
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,935.78 / $2,935.78 / $3,900.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.00 / $507.00 / $641.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,583.96 / $3,731.75 / $6,995.90
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.65 / $3,733.14 / $4,848.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$847.00 / $1,560.00 / $2,882.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,204.35 / $3,285.86 / $5,969.88
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,754.14 / $3,328.00 / $4,120.93