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Vermont 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
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,995.26 / $5,370.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $2,187.76 / $3,548.13
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,137.96 / $2,570.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,238.72 / $3,801.89