go back

Pennsylvania rates for HCPCS 21154

Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining autografts); without LeFort I

Facilitymedian $5,370 · 10th–90th $1,413–$8,5110%10%10th90th$5,370Professionalmedian $2,042 · 10th–90th $1,738–$3,8900%20%10th90th$2,042$10.0$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,412.54 / $5,370.32 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,995.26 / $3,548.13
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$20,417.38 / $21,379.62 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,754.23 / $2,754.23 / $3,019.95
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,621.81 / $2,398.83 / $3,981.07
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,630.27 / $3,388.44
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,290.87 / $3,630.78
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $4,265.80 / $8,511.38
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,995.26 / $3,890.45
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,511.89 / $2,951.21 / $4,466.84
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,905.46 / $1,905.46 / $3,019.95
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $1,905.46 / $3,019.95
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,344.23 / $5,754.40 / $19,054.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,621.81 / $2,238.72 / $3,981.07