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Delaware 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
$5,816.00 / $5,816.00 / $6,907.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,723.28 / $1,943.67 / $1,943.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,695.20 / $2,173.81 / $3,646.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,530.00 / $2,530.00 / $2,530.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,638.64 / $2,343.54 / $4,430.47