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Idaho 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
$3,388.44 / $4,466.84 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,754.23 / $4,466.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $8,511.38 / $10,715.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,548.13 / $4,168.69 / $4,265.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $3,019.95 / $3,801.89
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $3,467.37 / $5,495.41
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,019.95 / $3,548.13 / $4,677.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,165.95 / $7,585.78 / $10,232.93
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $4,168.69 / $4,570.88
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,862.09 / $4,570.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $10,232.93 / $27,542.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $3,235.94 / $4,466.84