go back

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
$1,804.53 / $4,790.00 / $11,576.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,818.50 / $2,130.85 / $2,841.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.00 / $400.00 / $10,000.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,841.32 / $2,764.53 / $4,367.54
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,624.00 / $21,162.00 / $32,051.00
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$963.35 / $2,003.89 / $2,535.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.76 / $1,565.39 / $2,687.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,581.00 / $10,309.00 / $15,888.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,675.52 / $2,352.28 / $4,096.04
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,536.79 / $1,536.79 / $2,122.98