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Hawaii 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
$1,924.00 / $2,747.00 / $5,484.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,079.88 / $2,079.88 / $2,079.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,898.68 / $2,415.30 / $2,898.36
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,735.65 / $3,073.58 / $3,573.93
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,125.46 / $2,318.69 / $2,705.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $2,912.00 / $2,912.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,970.88 / $2,415.30 / $3,120.95
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.27 / $1,891.78 / $3,653.19