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Idaho 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
$3,388.44 / $4,466.84 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $2,089.30 / $3,311.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,495.41 / $6,309.57 / $9,549.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $3,090.30 / $3,162.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,238.72 / $2,884.03
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $2,630.27 / $4,168.69
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,691.53 / $3,548.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,165.95 / $7,585.78 / $10,232.93
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $3,090.30 / $3,388.44
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,412.54 / $3,388.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $10,232.93 / $27,542.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,398.83 / $3,311.31