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New York 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
$2,037.00 / $4,629.00 / $10,674.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,755.93 / $2,156.34 / $3,680.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,079.00 / $7,359.00 / $12,869.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,601.76 / $2,093.81 / $4,757.43
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,750.41 / $2,750.41 / $37,499.62
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,750.41 / $2,750.41 / $2,750.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,204.04 / $2,204.04 / $2,204.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,918.67 / $3,132.49 / $7,357.15
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.00 / $3,023.00 / $5,023.37
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,109.33 / $2,930.20 / $4,308.93
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,811.36 / $1,811.36 / $1,811.36
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,626.96 / $2,328.92 / $4,108.27
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $597.00 / $2,204.04
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,011.00 / $2,940.67 / $6,928.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,264.00 / $5,963.00 / $14,457.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,782.83 / $2,497.42 / $6,127.30
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,328.92 / $2,328.92 / $9,955.20
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,767.86 / $2,524.31 / $4,922.96