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Washington, DC 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
$1,614.00 / $4,100.00 / $6,945.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,007.87 / $2,007.87 / $2,007.87
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,279.13 / $2,560.94 / $6,846.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,947.78 / $3,234.26 / $5,337.55
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,110.04 / $4,412.18 / $4,412.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,261.00 / $4,165.00 / $26,408.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.98 / $2,595.42 / $5,341.96