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New Mexico 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
$1,000.00 / $2,206.21 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,947.20 / $2,206.21 / $7,936.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,122.73 / $3,163.02 / $4,028.77
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $3,340.10
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,049.14 / $3,064.99 / $5,093.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,288.08 / $3,290.25 / $5,300.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$899.00 / $11,259.00 / $16,897.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,491.58 / $3,252.60 / $5,038.18