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Wyoming 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
Professional
Modifier
Low / Median / High Price
$2,137.10 / $2,182.44 / $2,724.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,131.00 / $4,957.00 / $7,500.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,011.87 / $4,364.88 / $5,977.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,188.00 / $5,188.00 / $18,767.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,771.14 / $4,332.41 / $7,550.40