go back

Ohio rates for HCPCS 21155

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

Facilitymedian $6,310 · 10th–90th $2,344$12,0230%5%10%10th90th$6,310Professionalmedian $2,455 · 10th–90th $1,950$5,0120%10%20%10th90th$2,455$20.0$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
$2,454.71 / $7,079.46 / $12,022.64
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,290.87 / $6,025.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,238.72 / $4,365.16 / $16,982.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,630.27 / $4,168.69
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,089.30 / $2,089.30 / $2,454.71
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21,379.62 / $21,379.62 / $21,379.62
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,905.46 / $2,951.21 / $4,365.16
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21,379.62 / $21,379.62 / $21,379.62
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $2,884.03 / $4,365.16
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $398.11
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $7,244.36
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $2,238.72 / $4,168.69
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,265.80 / $6,606.93 / $13,489.63
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,584.89 / $2,511.89 / $3,801.89