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Montana rates for HCPCS 21155

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

Facilitymedian $3,715 · 10th–90th $2,884–$4,1690%50%10th90th$3,715Professionalmedian $3,090 · 10th–90th $2,089–$5,3700%10%20%10th90th$3,090$100.0$200.0$500.0$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
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $3,019.95 / $5,888.44
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,388.44 / $3,388.44 / $3,388.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,630.27 / $3,019.95 / $3,630.78
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,630.78 / $3,715.35 / $3,981.07
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,630.78 / $3,715.35 / $3,981.07
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,398.83 / $3,311.31 / $4,677.35
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $2,951.21 / $4,466.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,398.83 / $2,398.83 / $12,022.64
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,344.23 / $3,548.13 / $4,466.84