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Hawaii 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
$1,924.00 / $2,747.00 / $5,484.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,651.80 / $1,651.80 / $1,651.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,569.62 / $2,003.73 / $2,404.46
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,123.34 / $2,385.64 / $2,774.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,763.28 / $1,923.58 / $2,244.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $2,912.00 / $2,912.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,635.04 / $2,003.73 / $2,652.93
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.27 / $1,451.02 / $2,811.01