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North Carolina rates for HCPCS 21155

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

Facilitymedian $3,890 · 10th–90th $2,138$10,4710%10%10th90th$3,890Professionalmedian $2,512 · 10th–90th $1,995$5,8880%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
$2,137.96 / $6,918.31 / $10,471.29
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,238.72 / $4,570.88
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,165.95 / $6,165.95 / $8,709.64
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,137.96 / $3,019.95 / $6,309.57
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$602.56 / $602.56 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,238.72 / $3,090.30 / $5,128.61
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,265.80 / $4,265.80 / $5,011.87
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,137.96 / $2,951.21 / $4,677.35
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,754.23 / $3,467.37 / $4,786.30
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,677.35 / $11,748.98 / $19,498.45
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $2,511.89 / $4,570.88
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $21,379.62 / $21,379.62
Wellcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23,442.29 / $23,442.29 / $23,442.29