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Nebraska rates for HCPCS 21275

Secondary revision of orbitocraniofacial reconstruction

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,241.22 / $11,611.47 / $24,068.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$770.98 / $770.98 / $4,447.89
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
$741.57 / $1,264.04 / $1,685.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,561.18 / $5,561.18 / $5,561.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,209.00 / $1,869.73 / $2,506.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$770.98 / $1,349.22 / $8,632.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,029.72 / $1,702.99 / $2,334.08
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,475.00 / $2,063.13 / $5,968.99
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,350.00 / $1,720.98 / $2,506.63
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
$1,029.72 / $1,722.37 / $2,217.85