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Utah 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
$3,019.95 / $6,025.60 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,454.71 / $10,471.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,754.23 / $4,265.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $4,073.80
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $9,772.37 / $21,379.62
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $3,801.89 / $5,754.40
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $3,548.13 / $4,677.35
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $3,090.30 / $4,570.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,137.96 / $3,311.31