go back

Arizona 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
$1,965.00 / $4,474.00 / $7,960.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,815.86 / $2,071.87 / $11,334.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,763.75 / $6,640.00 / $10,860.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,225.27 / $2,543.17 / $3,178.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,919.99 / $2,691.47 / $4,174.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,049.69 / $2,841.27 / $7,168.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,928.19 / $2,457.00 / $22,628.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,613.00 / $6,455.00 / $9,010.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,919.71 / $2,301.41 / $4,223.71