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Arizona rates for HCPCS 21188

Reconstruction midface, osteotomies (other than LeFort type) and bone grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,965.00 / $4,474.00 / $7,960.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,340.95 / $1,507.96 / $8,643.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,763.75 / $6,640.00 / $10,860.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,632.99 / $1,866.27 / $2,332.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,398.80 / $1,914.15 / $3,194.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,502.48 / $2,041.12 / $7,168.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,398.76 / $1,769.65 / $15,441.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,613.00 / $6,455.00 / $9,010.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,374.02 / $1,676.52 / $3,098.03