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Maryland rates for HCPCS 21188

Reconstruction midface, osteotomies (other than LeFort type) and bone grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,621.81 / $4,265.80
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,819.70 / $2,238.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $512.86 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,995.26 / $3,630.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,659.59 / $2,818.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,174.90 / $2,884.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,819.70 / $3,311.31
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,778.28 / $2,290.87