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Ohio 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
$1,984.00 / $6,075.00 / $11,627.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,612.69 / $1,790.69 / $3,503.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,142.00 / $14,428.74 / $24,745.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,533.26 / $2,182.63 / $3,567.80
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,586.60 / $1,730.83 / $2,520.33
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,843.61 / $1,866.58 / $2,375.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,763.49 / $2,467.12 / $3,670.41
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,047.39 / $2,047.39 / $2,047.39
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,781.74 / $2,604.73 / $3,670.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.10 / $1,239.55 / $2,111.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,206.00 / $6,231.00 / $10,075.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,490.04 / $2,268.50 / $3,637.31