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Oklahoma 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 $1,445–$7,9430%5%10%10th90th$3,890Professionalmedian $2,291 · 10th–90th $1,820–$3,4670%20%10th90th$2,291$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
$1,445.44 / $3,890.45 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,238.72 / $3,467.37
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$891.25 / $891.25 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $2,884.03 / $3,801.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,949.84 / $3,311.31 / $8,709.64
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $2,511.89 / $22,387.21
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,862.09 / $5,370.32 / $10,715.19
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $2,238.72 / $3,019.95