go back

Vermont 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
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,454.71 / $4,786.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,818.38 / $4,365.16
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,884.03 / $3,162.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,754.23 / $4,466.84