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Minnesota 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
$1,621.81 / $1,621.81 / $6,760.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,621.81 / $2,511.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $891.25 / $13,489.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $3,715.35 / $5,623.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $5,754.40 / $13,803.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $4,677.35 / $6,918.31
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $5,623.41 / $10,964.78
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,019.95 / $3,890.45 / $6,309.57
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $3,090.30 / $5,370.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $3,090.30 / $9,120.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $5,754.40 / $12,589.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $2,884.03 / $5,754.40