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Florida 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
$1,445.44 / $5,495.41 / $10,715.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,238.72 / $3,467.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $398.11 / $10,000.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,754.23 / $4,365.16
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,332.54 / $20,892.96 / $33,113.11
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,479.11 / $2,511.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $3,019.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $10,232.93 / $15,848.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,290.87 / $4,073.80
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $2,187.76