go back

Wisconsin 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
$1,905.46 / $3,981.07 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $1,949.84 / $5,128.61
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $10,964.78 / $18,197.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $3,981.07 / $9,772.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $5,888.44 / $9,332.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $7,943.28 / $8,912.51
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $3,981.07 / $7,244.36
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,467.37 / $4,570.88 / $5,888.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $4,168.69 / $13,489.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $3,630.78 / $19,498.45
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $3,981.07 / $6,165.95
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $17,782.79 / $17,782.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,388.44 / $9,332.54 / $19,498.45
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,309.57 / $6,309.57 / $6,309.57
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,165.95 / $10,715.19 / $12,302.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,585.78 / $12,302.69 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $3,019.95 / $7,943.28