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Maryland 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
Professional
Modifier
Low / Median / High Price
$1,755.93 / $2,007.87 / $2,210.33
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,279.13 / $2,560.94 / $2,817.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.00 / $507.00 / $641.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,837.59 / $2,688.56 / $4,599.84
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,004.54 / $2,592.98 / $3,376.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$847.00 / $847.00 / $1,560.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,617.97 / $2,224.86 / $4,207.78
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,952.49 / $2,311.57 / $2,861.42