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North Dakota 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
$1,942.91 / $1,942.91 / $8,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,942.91 / $1,943.27 / $2,135.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,837.31 / $4,221.24 / $4,949.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,385.98 / $4,705.59 / $6,267.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,942.91 / $2,920.35 / $3,302.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,022.46 / $3,564.27 / $5,036.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,022.46 / $3,532.91 / $4,449.41