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Wyoming 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
$1,928.30 / $1,968.49 / $2,462.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,725.00 / $4,470.00 / $6,762.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,715.90 / $3,936.97 / $5,393.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,188.00 / $5,188.00 / $18,767.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,385.08 / $3,943.80 / $7,042.07