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California 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
$1,992.00 / $8,090.00 / $18,309.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,345.41 / $1,626.91 / $8,643.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,314.00 / $10,474.00 / $21,865.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,699.22 / $2,321.15 / $4,592.35
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.40 / $100.00 / $8,208.49
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,315.06 / $1,914.70 / $4,266.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,277.00 / $2,277.00 / $2,277.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,549.49 / $2,014.34 / $4,459.05
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,218.17 / $1,843.44 / $2,313.35
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,488.00 / $2,059.04 / $3,687.33
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $14,426.72 / $14,754.40
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,441.12 / $15,441.12 / $15,441.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,653.33 / $2,078.94 / $3,147.70
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,571.96 / $2,094.46 / $4,320.60
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,362.84 / $5,362.84 / $5,362.84
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,495.24 / $1,827.25 / $2,304.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,830.00 / $12,341.00 / $26,451.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,257.39 / $1,692.26 / $3,603.32