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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
$4,241.22 / $10,431.19 / $20,928.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,477.41 / $1,477.41 / $8,643.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,522.85 / $8,579.33 / $16,595.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,413.88 / $2,406.32 / $3,213.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,518.00 / $3,602.56 / $4,876.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,477.41 / $2,585.46 / $7,441.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,021.16 / $3,293.20 / $4,568.62
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,920.28 / $3,655.91 / $4,935.95
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,566.00 / $3,260.85 / $4,876.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,178.00 / $7,441.00 / $8,816.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,021.16 / $3,342.69 / $4,290.96