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Utah 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
$2,281.12 / $4,387.00 / $8,344.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,458.69 / $2,281.12 / $8,643.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,571.96 / $2,266.37 / $3,394.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.95 / $923.18 / $1,459.08
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,238.37 / $10,273.82 / $14,749.55
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,047.38 / $2,675.83 / $3,933.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $7,693.00 / $13,847.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,378.15 / $1,724.80 / $2,638.58