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Arizona 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
$1,965.00 / $4,474.00 / $7,960.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.09 / $1,928.30 / $10,221.29
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,763.75 / $6,640.00 / $10,860.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,006.80 / $2,293.48 / $2,866.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,745.22 / $2,385.19 / $3,760.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,848.16 / $2,535.66 / $7,168.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.36 / $2,223.42 / $19,633.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,613.00 / $6,455.00 / $9,010.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,731.50 / $2,052.59 / $3,823.46