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South Carolina rates for HCPCS 21155

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

Facilitymedian $9,120 · 10th–90th $2,512–$18,1970%10%10th90th$9,120Professionalmedian $2,512 · 10th–90th $1,820–$4,8980%10%20%10th90th$2,512$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
$5,888.44 / $10,471.29 / $18,197.01
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $2,511.89 / $5,370.32
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,187.76 / $7,585.78 / $14,454.40
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $2,754.23 / $4,466.84
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
$2,041.74 / $2,951.21 / $5,248.07
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,137.96 / $3,019.95 / $4,786.30
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $33.11
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,365.16 / $15,488.17 / $25,703.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,778.28 / $2,290.87 / $3,801.89