go back

Texas rates for HCPCS 21155

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,086.00 / $3,620.00 / $12,480.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,933.06 / $2,206.21 / $3,650.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,174.15 / $3,634.56 / $11,176.65
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $1,815.88 / $1,848.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,447.00 / $2,447.00 / $2,447.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,179.12 / $2,876.10 / $4,523.79
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $19,610.56
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22,628.38 / $22,628.38 / $22,628.38
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.84 / $2,860.56 / $4,776.76
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,616.84 / $3,140.21 / $3,893.85
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,755.50 / $2,755.50 / $2,755.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,091.27 / $2,868.77 / $4,887.05
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,179.40 / $3,017.76 / $4,581.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,093.00 / $6,000.00 / $13,134.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,742.46 / $2,355.73 / $3,685.51
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,786.71 / $2,039.17 / $2,823.21