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Nevada 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
$2,150.00 / $3,042.00 / $6,953.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,947.20 / $2,223.96 / $11,334.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,877.00 / $5,379.00 / $14,000.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,420.54 / $2,718.32 / $3,540.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,799.74 / $2,812.09 / $3,870.53
Hometown Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.80 / $2,356.98 / $4,403.22
Hometown Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.60 / $2,734.67 / $6,004.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,042.00 / $4,794.00 / $10,407.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,980.28 / $2,660.58 / $3,918.69