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Washington rates for HCPCS 21155

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

Facilitymedian $5,129 · 10th–90th $2,630$19,4980%10%20%10th90th$5,129Professionalmedian $3,020 · 10th–90th $1,950$5,4950%10%20%10th90th$3,020$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
$4,073.80 / $8,128.31 / $20,892.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,511.89 / $5,370.32
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$11,481.54 / $14,791.08 / $28,840.32
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,951.21 / $4,168.69 / $5,888.44
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $3,548.13 / $6,456.54
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,290.87 / $4,365.16 / $9,120.11
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,290.87 / $4,168.69 / $6,918.31
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $138.04
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,630.27 / $4,168.69 / $4,168.69
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,884.03 / $2,884.03 / $2,951.21
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,951.21 / $4,265.80 / $5,623.41
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10,471.29 / $14,791.08 / $28,840.32
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,951.21 / $4,168.69 / $5,754.40
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,467.37 / $17,378.01 / $33,884.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,187.76 / $3,235.94 / $5,623.41
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,137.96 / $3,801.89