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California rates for HCPCS 21155

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

Facilitymedian $11,749 · 10th–90th $3,981$22,3870%5%10%10th90th$11,749Professionalmedian $2,754 · 10th–90th $1,950$8,9130%10%10th90th$2,754$50.0$200.0$1.0K$5.0K$20.0K

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
$3,548.13 / $8,912.51 / $21,379.62
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,398.83 / $8,912.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,943.28 / $13,489.63 / $22,387.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,511.89 / $3,388.44 / $6,456.54
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $7,943.28 / $15,135.61
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,511.89 / $3,548.13 / $6,918.31
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,238.72 / $2,884.03 / $5,754.40
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $2,089.30 / $2,818.38
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $2,238.72 / $4,677.35
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $56.23 / $21,379.62
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23,442.29 / $23,442.29 / $23,442.29
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,090.30 / $3,090.30 / $3,090.30
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $70.79
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,754.23 / $4,677.35
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,187.76 / $2,884.03 / $5,754.40
Sutter Health Plus
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7,079.46 / $7,079.46 / $7,079.46
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,380.38 / $1,862.09 / $2,344.23
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,456.54 / $11,748.98 / $25,118.86
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,344.23 / $5,248.07