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Missouri 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
$1,778.28 / $4,265.80 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,137.96 / $5,128.61
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $4,677.35 / $8,912.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,398.83 / $3,715.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,041.74 / $2,884.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,630.27 / $4,265.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $2,818.38 / $5,888.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,691.53 / $19,498.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $3,311.31 / $7,943.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,344.23 / $3,630.78