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Virginia 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
$1,879.88 / $5,412.00 / $11,024.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,505.00 / $1,660.13 / $2,078.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,685.00 / $17,371.00 / $24,194.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.97 / $1,849.07 / $3,057.06
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,849.01 / $1,849.89 / $7,889.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.00 / $640.00 / $1,765.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,540.35 / $2,084.33 / $3,528.27
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,502.78 / $1,923.56 / $2,239.08
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,636.87 / $2,137.21 / $3,231.25
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,043.00 / $2,297.00 / $3,106.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,511.97 / $2,050.23 / $6,585.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,511.97 / $2,050.23 / $6,585.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,423.00 / $11,475.00 / $21,639.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,249.70 / $1,878.48 / $3,075.92