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Maine 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
$1,445.44 / $1,819.70 / $4,265.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $2,290.87 / $3,388.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,344.23 / $3,548.13
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,137.96 / $3,981.07
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $2,290.87 / $4,570.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $2,089.30 / $3,162.28