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Oklahoma 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
$1,439.00 / $4,195.00 / $13,200.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,634.30 / $2,056.36 / $2,056.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$900.00 / $900.00 / $900.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,062.09 / $2,685.00 / $3,378.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,835.30 / $2,932.77 / $8,085.52
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,719.09 / $2,265.75 / $19,633.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,481.00 / $5,910.00 / $9,232.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,617.97 / $2,083.13 / $2,920.30