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Missouri 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
$1,593.47 / $5,389.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,332.79 / $1,593.47 / $2,534.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,224.00 / $4,490.00 / $12,405.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,589.58 / $1,931.75 / $3,015.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,529.40 / $2,140.98 / $3,603.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,317.30 / $2,193.04 / $4,813.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,580.13 / $2,254.23 / $15,441.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,858.00 / $4,000.00 / $11,258.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,512.62 / $2,100.86 / $3,394.70