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Minnesota 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
$1,949.84 / $1,949.84 / $6,760.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,995.26 / $3,162.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $6,025.60 / $15,848.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.30 / $4,570.88 / $7,079.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $7,079.46 / $16,595.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,388.44 / $5,623.41 / $8,511.38
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,370.32 / $6,760.83 / $13,182.57
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,630.78 / $4,786.30 / $7,585.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $3,630.78 / $5,754.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $3,630.78 / $10,715.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $5,754.40 / $12,589.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $3,467.37 / $6,918.31