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Iowa 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
$4,146.00 / $5,091.00 / $7,120.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,797.24 / $2,810.54 / $3,095.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,783.61 / $4,403.37 / $5,430.33
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,785.30 / $2,879.07 / $6,943.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,963.46 / $4,759.35 / $7,454.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,120.92 / $3,916.06 / $19,633.29
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,595.22 / $4,513.45 / $5,903.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,897.29 / $4,247.42 / $5,903.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,221.00 / $8,060.00 / $11,869.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,958.03 / $2,983.66 / $5,861.76
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,958.79 / $3,745.30 / $4,406.20