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Nebraska rates for HCPCS 21155

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

Facilitymedian $7,943 · 10th–90th $3,715$14,4540%10%20%10th90th$7,943Professionalmedian $3,236 · 10th–90th $1,995$7,0790%20%10th90th$3,236$1.0K$2.0K$5.0K$10.0K$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
$5,011.87 / $7,943.28 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $3,090.30 / $11,748.98
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9,120.11 / $11,748.98 / $22,908.68
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,905.46 / $3,235.94 / $4,365.16
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,754.40 / $5,754.40 / $5,754.40
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,344.23 / $4,897.79 / $6,165.95
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $3,467.37 / $8,912.51
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,454.71 / $4,073.80 / $22,387.21
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,168.69 / $5,011.87 / $6,606.93
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,754.40 / $5,754.40 / $5,754.40
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,168.69 / $4,677.35 / $6,606.93
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,309.57 / $7,413.10 / $9,120.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,454.71 / $3,890.45 / $5,495.41