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Nebraska 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
$4,241.22 / $10,431.19 / $20,928.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,797.24 / $1,797.24 / $10,221.29
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,086.90 / $11,951.75 / $23,118.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,725.24 / $2,940.75 / $3,921.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,290.00 / $4,344.26 / $5,903.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,797.24 / $3,145.17 / $7,441.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,396.63 / $3,963.65 / $6,057.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,235.56 / $4,467.84 / $6,005.68
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,342.44 / $4,247.42 / $5,903.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,178.00 / $7,441.00 / $8,816.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,396.63 / $4,163.83 / $5,161.97