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Connecticut 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
$3,890.45 / $6,025.60 / $10,964.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,187.76 / $5,754.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $15,135.61 / $16,595.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $4,073.80 / $5,888.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $851.14 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $3,630.78 / $5,370.32
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $3,090.30 / $3,890.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,677.35 / $10,232.93 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,951.21 / $5,495.41