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Massachusetts rates for HCPCS 21155

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

Facilitymedian $3,631 · 10th–90th $2,239–$7,0790%10%10th90th$3,631Professionalmedian $2,570 · 10th–90th $1,950–$5,3700%10%20%10th90th$2,570$100.0$500.0$2.0K$10.0K$50.0K

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
$2,238.72 / $3,630.78 / $5,623.41
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,398.83 / $5,248.07
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $5,370.32 / $16,595.87
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $3,388.44 / $23,442.29
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $3,235.94 / $6,165.95
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,862.09 / $2,570.40 / $4,677.35
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,511.89 / $3,548.13
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,019.95 / $6,165.95 / $13,182.57
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,905.46 / $3,467.37 / $4,897.79
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $5,370.32 / $16,595.87
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $3,388.44 / $23,442.29
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,511.89 / $5,888.44 / $13,803.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,238.72 / $3,467.37 / $5,754.40