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Missouri rates for HCPCS 21155

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

Facilitymedian $4,365 · 10th–90th $2,089–$8,5110%10%10th90th$4,365Professionalmedian $2,512 · 10th–90th $1,905–$4,5710%10%20%10th90th$2,512$100.0$500.0$2.0K$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
$1,819.70 / $4,466.84 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $2,290.87 / $4,786.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,238.72 / $4,677.35 / $8,912.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,187.76 / $2,754.23 / $4,168.69
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,905.46 / $2,238.72 / $3,090.30
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,778.28 / $2,884.03 / $4,677.35
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,288.25 / $3,162.28 / $6,025.60
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $3,090.30 / $22,387.21
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,454.71 / $3,715.35 / $6,309.57
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,905.46 / $2,570.40 / $3,890.45