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Massachusetts 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
$2,041.74 / $3,630.78 / $5,623.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,187.76 / $5,128.61
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $5,011.87 / $16,595.87
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $3,019.95 / $19,498.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $3,019.95 / $5,370.32
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $2,691.53 / $8,511.38
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,344.23 / $3,235.94
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $6,165.95 / $13,182.57
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $3,090.30 / $4,570.88
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $5,011.87 / $16,595.87
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $3,019.95 / $19,498.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $6,309.57 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $3,019.95 / $5,248.07