go back

Virginia 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 $2,188–$10,9650%5%10%10th90th$3,715Professionalmedian $2,455 · 10th–90th $1,905–$4,8980%10%20%10th90th$2,455$500.0$1.0K$2.0K$5.0K$10.0K$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
$2,238.72 / $5,495.41 / $10,000.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $2,238.72 / $4,466.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,606.93 / $7,413.10 / $9,332.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $3,090.30 / $5,248.07
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,187.76 / $3,235.94 / $10,000.00
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $645.65 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,884.03 / $4,570.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,778.28 / $2,238.72 / $2,630.27
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,388.44 / $4,265.80 / $5,011.87
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,137.96 / $2,818.38 / $4,365.16
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,090.30 / $3,090.30 / $3,090.30
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,884.03 / $10,000.00
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,884.03 / $10,000.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,456.54 / $10,471.29 / $21,379.62
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $2,691.53 / $4,365.16