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West Virginia 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
$1,400.00 / $1,916.09 / $2,937.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.52 / $2,007.87 / $2,810.54
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,048.63 / $2,274.67 / $2,478.29
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,130.33 / $2,202.92 / $2,202.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,204.04 / $2,204.04 / $2,204.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,875.96 / $2,865.48 / $6,282.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,563.98 / $2,570.08 / $3,354.05