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Nebraska rates for HCPCS 21142

Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, without bone graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,005.00 / $10,563.53 / $24,068.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,198.75 / $1,399.83 / $3,194.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,086.90 / $11,951.75 / $23,118.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,223.75 / $2,085.92 / $2,781.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,154.73 / $3,126.53 / $4,203.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,278.42 / $2,237.23 / $8,757.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,716.68 / $2,839.12 / $3,874.47
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,691.21 / $2,991.96 / $4,209.92
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,191.81 / $2,878.27 / $4,203.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,178.00 / $7,441.00 / $8,816.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,716.68 / $2,894.56 / $3,483.53