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Wisconsin rates for HCPCS 21154

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

Facilitymedian $10,000 · 10th–90th $4,571–$16,9820%5%10%10th90th$10,000Professionalmedian $2,884 · 10th–90th $1,778–$8,9130%20%10th90th$2,884$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
$1,905.46 / $3,981.07 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,778.28 / $1,949.84 / $4,786.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,606.93 / $10,964.78 / $18,197.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $3,981.07 / $9,772.37
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $5,888.44 / $9,332.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,344.23 / $7,943.28 / $8,912.51
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,949.84 / $4,168.69 / $7,413.10
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,467.37 / $4,570.88 / $5,888.44
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,949.84 / $4,168.69 / $13,489.63
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $3,630.78 / $19,498.45
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,981.07 / $9,332.54 / $15,848.93
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,398.83 / $4,786.30 / $8,128.31
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,630.27 / $3,981.07 / $6,025.60
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $17,782.79 / $17,782.79
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,388.44 / $9,332.54 / $19,498.45
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6,309.57 / $6,309.57 / $6,309.57
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6,165.95 / $10,715.19 / $12,302.69
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,585.78 / $12,022.64 / $15,848.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $3,019.95 / $7,943.28