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Minnesota rates for HCPCS 21155

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

Facilitymedian $6,310 · 10th–90th $2,138–$15,4880%5%10%10th90th$6,310Professionalmedian $4,677 · 10th–90th $2,138–$7,7620%10%10th90th$4,677$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
$2,137.96 / $2,137.96 / $6,760.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,238.72 / $3,467.37
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,238.72 / $6,025.60 / $17,378.01
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,630.78 / $5,370.32 / $7,762.47
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,495.41 / $7,762.47 / $18,620.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,801.89 / $6,309.57 / $9,332.54
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,025.60 / $7,413.10 / $14,454.40
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $5,248.07 / $8,317.64
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,187.76 / $3,981.07 / $7,943.28
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,137.96 / $4,073.80 / $11,748.98
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,584.89 / $6,760.83 / $15,135.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,187.76 / $4,073.80 / $7,762.47