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Michigan rates for HCPCS 21155

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

Facilitymedian $4,898 · 10th–90th $2,754–$8,7100%50%10th90th$4,898Professionalmedian $2,344 · 10th–90th $1,950–$3,8020%20%10th90th$2,344$1.0K$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,754.23 / $4,897.79 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,187.76 / $3,801.89
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,235.94 / $3,235.94 / $3,235.94
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $3,235.94 / $3,388.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,778.28 / $2,691.53 / $3,630.78
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,754.23 / $4,897.79 / $6,918.31
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,511.89 / $4,466.84
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,621.81 / $2,754.23 / $3,467.37
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,265.80 / $7,762.47 / $14,791.08
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,630.27 / $3,467.37