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Arkansas rates for HCPCS 21145

Reconstruction midface, LeFort I; single piece, segment movement in any direction, requiring bone grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $1,905.46 / $2,511.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,621.81 / $5,495.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $2,187.76 / $2,691.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $4,073.80 / $11,748.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,778.28 / $2,884.03