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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
$3,422.00 / $4,500.00 / $8,622.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,155.19 / $3,064.99 / $4,458.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,430.83 / $3,288.57 / $3,833.61
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,048.08 / $4,178.66 / $5,394.63
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,454.23 / $3,768.25 / $5,094.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $2,994.72 / $3,767.56
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,072.74 / $7,629.08 / $12,587.97
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,665.41 / $4,312.25 / $5,094.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,100.00 / $10,120.00 / $27,159.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,363.59 / $3,472.21 / $5,099.81