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West 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
$1,400.00 / $1,528.29 / $2,334.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,528.29 / $1,636.87 / $2,451.91
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,506.79 / $1,649.86 / $1,970.00
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$898.54 / $1,751.11 / $1,751.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,765.39 / $1,765.39 / $1,765.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,507.94 / $2,290.61 / $4,444.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,249.53 / $1,850.19 / $2,605.92