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Alaska rates for HCPCS 21151

Reconstruction midface, LeFort II; any direction, requiring bone grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,315.32 / $9,774.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,685.55 / $9,014.96 / $9,014.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,533.02 / $6,090.24 / $7,761.17
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,693.15 / $9,014.96 / $12,620.96
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,382.14 / $5,258.58 / $10,675.43
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,560.00 / $8,957.76 / $11,128.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,693.15 / $9,014.96 / $12,620.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,743.46 / $8,853.60 / $11,642.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,775.89 / $7,350.23 / $10,718.84