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Pennsylvania rates for HCPCS 21155

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

Facilitymedian $5,370 · 10th–90th $1,413–$8,5110%10%10th90th$5,370Professionalmedian $2,239 · 10th–90th $1,905–$3,8020%20%40%10th90th$2,239$10.0$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
$1,412.54 / $5,370.32 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,187.76 / $3,467.37
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$20,417.38 / $21,379.62 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,090.30 / $3,090.30 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,778.28 / $2,691.53 / $4,365.16
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,187.76 / $2,951.21 / $3,801.89
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,905.46 / $2,570.40 / $3,981.07
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $4,265.80 / $8,511.38
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $2,187.76 / $3,467.37
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,754.23 / $3,235.94 / $4,786.30
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,137.96 / $2,137.96 / $3,090.30
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,137.96 / $2,238.72
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,344.23 / $5,754.40 / $19,054.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,778.28 / $2,511.89 / $4,365.16