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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
$1,704.00 / $5,389.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,646.66 / $1,970.52 / $3,106.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,224.00 / $4,490.00 / $12,405.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,935.35 / $2,412.62 / $3,818.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,942.79 / $2,688.95 / $4,467.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,646.66 / $2,788.90 / $5,422.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,982.88 / $2,750.19 / $19,633.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,858.00 / $4,000.00 / $11,258.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,870.53 / $2,528.08 / $4,194.14