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Maryland rates for HCPCS 21183

Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra- and extracranial excision of benign tumor of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes obtaining grafts); total area of bone grafting greater than 40 sq cm but less than 80 sq cm

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,046.54 / $2,372.91 / $2,610.14
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,650.00 / $2,700.19 / $2,970.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.00 / $507.00 / $641.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,168.81 / $3,086.68 / $5,232.33
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,384.39 / $3,092.43 / $4,015.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$774.00 / $847.00 / $2,201.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,765.74 / $2,547.17 / $4,987.21
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,195.03 / $2,756.81 / $3,394.19