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Alaska rates for HCPCS 21155

Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining autografts); with LeFort I

Facilitymedian $4,074 · 10th–90th $2,239–$14,1250%5%10%10th90th$4,074Professionalmedian $3,020 · 10th–90th $2,042–$8,9130%20%10th90th$3,020$100.0$500.0$2.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,344.23 / $10,000.00 / $16,982.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,754.23 / $6,456.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,238.72 / $3,235.94 / $7,244.36
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $3,890.45 / $11,748.98
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $6,025.60 / $10,715.19
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8,709.64 / $8,709.64 / $12,589.25
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $3,715.35 / $11,748.98
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $2,951.21 / $7,244.36
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,754.40 / $5,754.40 / $12,022.64
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $5,888.44 / $12,882.50