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Arizona rates for HCPCS 21155

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

Facilitymedian $4,786 · 10th–90th $2,089–$8,7100%5%10%10th90th$4,786Professionalmedian $2,291 · 10th–90th $1,950–$5,1290%20%10th90th$2,291$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,089.30 / $4,677.35 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,238.72 / $5,370.32
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,659.59 / $7,413.10 / $13,489.63
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,570.40 / $2,951.21 / $5,623.41
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,630.27 / $4,265.80
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,041.74 / $3,019.95 / $8,128.31
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,691.53 / $22,387.21
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,168.69 / $5,495.41 / $8,709.64
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $2,290.87 / $3,981.07