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Georgia 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
$3,090.30 / $5,370.32 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,137.96 / $4,365.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $3,801.89 / $6,918.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $3,162.28 / $4,365.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $2,511.89 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $3,162.28 / $5,011.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,754.23 / $10,715.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $6,918.31 / $12,022.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,754.23 / $4,365.16