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New Mexico 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
$1,000.00 / $2,095.00 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,755.75 / $1,989.63 / $7,851.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,062.09 / $2,959.54 / $4,017.61
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $3,008.62
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,845.78 / $2,669.32 / $4,494.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,083.51 / $3,125.27 / $4,779.97
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$899.00 / $11,259.00 / $16,897.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,017.44 / $2,915.01 / $4,539.22