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Ohio 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
$1,984.00 / $6,075.00 / $11,627.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,332.79 / $1,577.11 / $2,805.71
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,142.00 / $14,428.74 / $24,745.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,277.75 / $1,813.47 / $2,885.69
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,375.35 / $1,500.38 / $2,184.75
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,561.66 / $1,618.06 / $2,059.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,522.08 / $2,093.05 / $3,101.00
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,765.39 / $1,765.39 / $1,765.39
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,544.51 / $2,151.59 / $3,127.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.74 / $1,090.53 / $1,834.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,206.00 / $6,231.00 / $10,075.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,331.75 / $1,943.10 / $3,255.02