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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
$3,422.00 / $4,500.00 / $8,622.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,943.27 / $3,009.24 / $4,018.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,192.21 / $2,971.90 / $3,453.98
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,844.99 / $3,831.27 / $4,862.10
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,114.77 / $3,397.93 / $4,592.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $3,048.20 / $3,396.57
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,072.74 / $7,629.08 / $12,587.97
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,305.11 / $3,888.36 / $4,592.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,100.00 / $10,120.00 / $27,159.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,177.03 / $3,026.17 / $4,412.53