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Maine rates for HCPCS 21275

Secondary revision of orbitocraniofacial reconstruction

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$702.48 / $889.17 / $1,070.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$884.22 / $1,144.29 / $1,613.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$860.79 / $1,284.22 / $1,825.96
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,053.58 / $1,218.99 / $1,870.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$702.48 / $975.85 / $1,070.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$805.48 / $1,127.67 / $1,681.43