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Colorado 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
$2,018.00 / $5,503.00 / $10,651.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,984.73 / $2,137.10 / $3,021.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,946.00 / $9,834.00 / $18,248.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,384.03 / $3,038.17 / $4,872.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,373.28 / $3,006.89 / $4,290.58
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.10 / $2,962.32 / $3,804.04
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,327.53 / $3,068.11 / $4,231.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,251.00 / $11,924.00 / $19,712.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,291.78 / $3,109.99 / $4,848.03