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Utah rates for HCPCS 21155

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

Facilitymedian $6,026 · 10th–90th $3,162–$10,2330%10%10th90th$6,026Professionalmedian $3,090 · 10th–90th $1,950–$11,7490%10%20%10th90th$3,090$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
$3,090.30 / $6,025.60 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $3,090.30 / $13,182.57
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,951.21 / $4,570.88
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $4,168.69
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8,317.64 / $10,471.29 / $15,135.61
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,630.27 / $3,548.13 / $6,025.60
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $3,981.07 / $5,248.07
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $3,090.30 / $4,570.88
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $2,290.87 / $3,715.35