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Pennsylvania rates for HCPCS 21160

Reconstruction midface, LeFort III (extra and intracranial) with forehead advancement (eg, mono bloc), requiring bone grafts (includes obtaining autografts); with LeFort I

Facilitymedian $5,370 · 10th–90th $1,413–$8,5110%10%10th90th$5,370Professionalmedian $2,884 · 10th–90th $2,399–$4,8980%20%40%10th90th$2,884$10.0$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
$1,412.54 / $5,370.32 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,398.83 / $2,818.38 / $4,466.84
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$20,417.38 / $21,379.62 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $3,981.07 / $4,265.80
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,290.87 / $3,388.44 / $5,495.41
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,818.38 / $3,801.89 / $4,897.79
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,454.71 / $3,235.94 / $5,011.87
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $4,265.80 / $8,511.38
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,344.23 / $2,818.38 / $4,466.84
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,548.13 / $3,981.07 / $5,623.41
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,754.23 / $2,754.23 / $3,162.28
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,691.53 / $2,754.23 / $3,162.28
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,344.23 / $5,754.40 / $19,054.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,290.87 / $3,162.28 / $5,623.41