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Wyoming 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
$1,547.91 / $1,570.87 / $1,991.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,948.00 / $3,538.00 / $5,352.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,189.21 / $3,141.74 / $4,299.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,188.00 / $5,188.00 / $18,767.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,757.90 / $3,129.51 / $5,181.78