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Maryland rates for HCPCS 40654

Repair lip, full thickness; over one-half vertical height, or complex

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$187.80 / $187.80 / $187.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$381.81 / $514.27 / $710.34
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$462.97 / $463.64 / $542.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$428.00 / $585.77 / $979.58
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$610.17 / $725.35 / $1,198.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.00 / $450.00 / $2,962.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.62 / $574.54 / $1,093.05
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.16 / $477.81 / $706.86