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Nebraska rates for HCPCS 21145

Reconstruction midface, LeFort I; single piece, segment movement in any direction, requiring bone grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $7,943.28 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,584.89 / $5,128.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,120.11 / $11,748.98 / $22,908.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,344.23 / $3,162.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $6,025.60 / $6,025.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $3,467.37 / $4,570.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $2,511.89 / $8,912.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,951.21 / $13,803.84
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,019.95 / $3,630.78 / $4,786.30
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $6,025.60 / $6,025.60
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,467.37 / $3,630.78 / $4,786.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,309.57 / $7,413.10 / $9,120.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,818.38 / $3,981.07