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Nebraska 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
$5,011.87 / $7,943.28 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,187.76 / $11,748.98
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,120.11 / $11,748.98 / $22,908.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $3,235.94 / $4,365.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,754.40 / $5,754.40 / $5,754.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $4,677.35 / $6,165.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $3,467.37 / $8,912.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $4,073.80 / $22,387.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,168.69 / $5,011.87 / $6,606.93
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,754.40 / $5,754.40 / $5,754.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,677.35 / $4,897.79 / $6,606.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,309.57 / $7,413.10 / $9,120.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $3,890.45 / $5,495.41