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West Virginia rates for HCPCS 21155

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

Facilitymedian $2,138 · 10th–90th $1,413–$3,6310%20%40%10th90th$2,138Professionalmedian $2,138 · 10th–90th $1,950–$3,8020%20%10th90th$2,138$50.0$200.0$1.0K$5.0K

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
$1,412.54 / $2,137.96 / $2,290.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,089.30 / $3,801.89
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,290.87 / $2,290.87 / $2,754.23
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,454.71 / $2,454.71 / $2,454.71
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$34.67 / $3,630.78 / $3,630.78
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $3,388.44 / $14,454.40
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,548.13 / $3,548.13 / $16,595.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $2,570.40 / $3,801.89