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Vermont rates for HCPCS 21155

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

Professionalmedian $2,692 · 10th–90th $1,862–$6,6070%20%10th90th$2,692$500.0$1.0K$2.0K$5.0K$10.0K

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
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $2,691.53 / $6,606.93
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $3,162.28 / $4,365.16
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,238.72 / $2,951.21 / $3,548.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,238.72 / $3,090.30 / $5,011.87