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Idaho 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
$3,388.44 / $4,466.84 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,454.71 / $3,981.07
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $7,943.28 / $10,232.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,162.28 / $3,715.35 / $3,890.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,691.53 / $3,467.37
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $3,162.28 / $5,128.61
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,754.23 / $3,162.28 / $4,168.69
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,165.95 / $7,585.78 / $10,232.93
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $3,801.89 / $4,073.80
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,698.24 / $4,073.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $10,232.93 / $27,542.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,951.21 / $4,168.69