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Alaska rates for HCPCS 21154

Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining autografts); without LeFort I

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,721.08 / $9,774.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,813.82 / $9,703.17 / $9,703.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,876.63 / $6,554.73 / $8,350.57
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,823.53 / $9,703.17 / $13,584.44
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,719.35 / $5,663.22 / $11,496.92
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,057.50 / $9,638.87 / $11,816.70
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,823.53 / $9,703.17 / $13,584.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,953.78 / $9,526.79 / $12,756.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,003.93 / $8,987.46 / $11,536.32