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Delaware 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
$5,816.00 / $5,816.00 / $6,907.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,910.90 / $2,154.77 / $2,154.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,880.10 / $2,306.19 / $3,974.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,530.00 / $2,530.00 / $2,530.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,818.56 / $2,625.46 / $4,916.93