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New Mexico 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
$1,595.94 / $3,090.35 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,297.89 / $1,509.27 / $1,999.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,370.99 / $2,192.65 / $2,838.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $2,378.01
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,433.71 / $1,940.53 / $3,449.64
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,461.76 / $2,265.73 / $3,798.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$899.00 / $11,259.00 / $16,897.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,691.83 / $2,201.57 / $3,517.07