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Idaho rates for HCPCS 21155

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

Facilitymedian $5,129 · 10th–90th $2,399–$9,5500%10%10th90th$5,129Professionalmedian $3,162 · 10th–90th $2,042–$4,4670%10%10th90th$3,162$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
$3,388.44 / $4,466.84 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,754.23 / $4,466.84
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,025.60 / $8,511.38 / $10,715.19
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,548.13 / $4,168.69 / $4,265.80
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,818.38 / $3,801.89
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,089.30 / $3,388.44 / $5,495.41
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,019.95 / $3,467.37 / $4,897.79
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,165.95 / $7,585.78 / $10,232.93
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,162.28 / $4,265.80 / $4,570.88
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,949.84 / $4,570.88
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,089.30 / $12,022.64 / $27,542.29
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,238.72 / $3,235.94 / $4,570.88