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Texas rates for HCPCS 21155

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

Facilitymedian $3,715 · 10th–90th $1,230$12,3030%10%10th90th$3,715Professionalmedian $2,344 · 10th–90th $1,905$4,0740%20%40%10th90th$2,344$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
$1,122.02 / $3,715.35 / $12,882.50
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,290.87 / $3,801.89
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,238.72 / $3,715.35 / $12,302.69
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $1,819.70 / $1,862.09
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,630.78 / $3,630.78 / $3,630.78
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,884.03 / $4,677.35
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $56.23 / $21,379.62
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23,442.29 / $23,442.29 / $23,442.29
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,819.70 / $3,019.95 / $5,623.41
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,691.53 / $4,466.84
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $275.42 / $1,819.70
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,754.23 / $2,754.23 / $2,754.23
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,884.03 / $5,011.87
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,818.38 / $4,466.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,238.72 / $6,165.95 / $11,481.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,778.28 / $2,344.23 / $3,715.35
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,778.28 / $1,819.70 / $1,905.46