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Nebraska rates for HCPCS 21431

Closed treatment of craniofacial separation (LeFort III type) using interdental wire fixation of denture or splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,241.22 / $10,431.19 / $20,928.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$650.36 / $650.36 / $3,737.34
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,086.90 / $11,951.75 / $23,118.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$622.64 / $1,061.32 / $1,415.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,035.00 / $1,595.01 / $2,138.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$650.36 / $1,138.13 / $4,890.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$863.98 / $1,428.89 / $1,971.42
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$865.93 / $1,524.02 / $2,164.92
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.24 / $1,457.95 / $2,138.32
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
$863.98 / $1,548.78 / $1,753.21