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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
$1,943.27 / $1,943.27 / $6,575.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,928.30 / $2,052.06 / $3,095.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,184.29 / $9,050.54 / $16,151.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,360.65 / $5,424.45 / $6,843.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,689.83 / $6,654.20 / $16,007.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,488.36 / $5,556.87 / $8,252.79
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,263.49 / $6,083.53 / $12,604.39
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,158.25 / $5,002.89 / $7,568.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,110.28 / $3,284.13 / $5,716.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,083.13 / $3,741.55 / $7,765.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,940.00 / $7,872.00 / $11,531.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,083.13 / $3,637.94 / $7,580.89