go back

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
$1,443.29 / $1,636.87 / $1,879.88
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,675.00 / $1,849.89 / $2,034.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.00 / $507.00 / $641.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,485.51 / $2,129.26 / $3,722.42
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,624.93 / $2,096.16 / $2,755.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$847.00 / $847.00 / $1,560.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,260.11 / $1,875.56 / $3,329.57
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,543.15 / $1,868.67 / $2,324.27