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Nationwide rates for HCPCS 21155

Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining autografts); with LeFort I

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $5,011.87 / $11,481.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,238.72 / $4,786.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $10,964.78 / $21,379.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,884.03 / $5,370.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $5,623.41 / $15,488.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $3,235.94 / $6,606.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $7,244.36 / $16,595.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,630.27 / $4,786.30