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Maine rates for HCPCS 21155

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

Facilitymedian $12,023 · 10th–90th $12,023–$12,0230%50%100%$12,023Professionalmedian $2,692 · 10th–90th $1,995–$5,3700%10%10th90th$2,692$2.0K$5.0K$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,570.40 / $5,370.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $3,090.30 / $4,570.88
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,454.71 / $3,235.94 / $4,786.30
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,290.87 / $2,818.38 / $5,248.07
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $2,511.89 / $3,019.95
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12,022.64 / $12,022.64 / $12,022.64
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,754.23 / $4,677.35