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New York rates for HCPCS 21155

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

Facilitymedian $5,623 · 10th–90th $2,512$12,0230%10%10th90th$5,623Professionalmedian $2,455 · 10th–90th $1,862$6,0260%20%10th90th$2,455$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
$2,398.83 / $4,677.35 / $10,964.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,398.83 / $5,495.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,073.80 / $7,762.47 / $13,803.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,778.28 / $2,238.72 / $5,370.32
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,019.95 / $3,019.95 / $37,153.52
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,019.95 / $3,019.95 / $3,019.95
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$34.67 / $3,630.78 / $50,118.72
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $3,548.13 / $9,772.37
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,187.76 / $3,311.31 / $7,079.46
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,951.21 / $4,168.69
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $1,995.26 / $1,995.26
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,818.38 / $4,570.88
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,511.89 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $2,884.03 / $4,677.35
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,398.83 / $5,495.41 / $12,589.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,905.46 / $2,951.21 / $9,120.11
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,737.80 / $2,570.40 / $11,220.18
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,778.28 / $2,630.27 / $5,888.44