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Iowa rates for HCPCS 21155

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

Facilitymedian $5,012 · 10th–90th $3,467–$10,9650%10%10th90th$5,012Professionalmedian $2,512 · 10th–90th $1,995–$5,6230%20%10th90th$2,512$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
$3,467.37 / $4,786.30 / $7,079.46
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,398.83 / $4,466.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,818.38 / $4,897.79 / $6,165.95
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,951.21 / $7,079.46
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,951.21 / $5,248.07 / $11,481.54
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,238.72 / $4,168.69 / $22,387.21
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,677.35 / $5,370.32 / $5,754.40
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,168.69 / $4,168.69 / $5,754.40
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,413.10 / $10,964.78 / $15,488.17
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $3,162.28 / $6,165.95
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,311.31 / $4,168.69 / $4,897.79