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Arizona 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
$2,100.00 / $4,005.00 / $7,562.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,297.89 / $1,403.74 / $3,114.63
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,763.75 / $6,640.00 / $10,860.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,605.18 / $1,834.49 / $2,293.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,345.41 / $1,820.26 / $3,136.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,461.63 / $1,941.67 / $7,168.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,335.96 / $1,687.76 / $13,677.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,613.00 / $6,455.00 / $9,010.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,309.09 / $1,586.80 / $2,973.49