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Oregon rates for HCPCS 21155

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

Facilitymedian $4,169 · 10th–90th $2,884–$10,7150%20%10th90th$4,169Professionalmedian $3,548 · 10th–90th $1,995–$5,8880%10%10th90th$3,548$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
$4,265.80 / $5,495.41 / $13,803.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,290.87 / $5,888.44
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$851.14 / $851.14 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,630.27 / $4,073.80 / $5,623.41
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,951.21 / $3,981.07 / $5,128.61
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,238.72 / $3,630.78 / $5,370.32
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,235.94 / $3,890.45 / $5,495.41
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,884.03 / $4,168.69 / $4,365.16
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,238.72 / $3,630.78 / $5,128.61
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $4,168.69 / $5,754.40
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,623.41 / $14,791.08 / $22,387.21
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $4,897.79 / $6,456.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $17,782.79 / $25,703.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,884.03 / $4,265.80 / $5,888.44