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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
$1,995.26 / $5,128.61 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $1,995.26 / $5,754.40
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $3,715.35 / $10,715.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,951.21 / $5,370.32
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $3,981.07 / $4,365.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $16,218.10 / $33,884.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,570.40 / $5,370.32