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Nebraska 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
$5,011.87 / $7,943.28 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,621.81 / $8,709.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $8,511.38 / $16,595.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $2,398.83 / $3,235.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,754.40 / $5,754.40 / $5,754.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $3,467.37 / $4,570.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $2,511.89 / $8,912.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $3,019.95 / $15,488.17
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.30 / $3,801.89 / $4,897.79
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,754.40 / $5,754.40 / $5,754.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,467.37 / $3,630.78 / $4,897.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,309.57 / $7,413.10 / $9,120.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,951.21 / $4,073.80