CPT 21155
Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Lefort iii w/ lefort i
Low
$998
Average
$5.7k
Median
$5.0k
High
$18.0k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
56 payers; the 90th percentile is 4.0× the 10th. Each bar is a price range and its height is how many payers fall in it. Hover a bar, or a row in the ladder, for details.
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| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | UnitedHealthcare case rate · outpatient · +19 other terms | 373 | $9.5k | $9.1k | $4.7k | 51% | — | $1 – $36.5k |
| 2 | Aetna fee schedule · outpatient · +19 other terms | 315 | $6.3k | $7.0k | $6.0k | 86% | — | $79 – $69.2k |
| 3 | Blue Cross Blue Shield fee schedule · outpatient · +15 other terms | 283 | $9.9k | $19.0k | $16.1k | 85% | — | $0 – $76.6k |
| 4 | Cigna case rate · outpatient · +15 other terms | 221 | $6.8k | $12.7k | $8.7k | 68% | — | $1 – $40.7k |
| 5 | Humana fee schedule · outpatient · +16 other terms | 167 | $5.8k | $5.2k | $2.4k | 46% | — | $1.7k – $17.1k |
| 6 | Anthem fee schedule · outpatient · +13 other terms | 101 | $2.8k | $6.9k | $7.5k | 108% | — | $1.3k – $43.3k |
| 7 | Molina fee schedule · outpatient · +11 other terms | 90 | $7.1k | $6.5k | $3.9k | 59% | — | $266 – $13.7k |
| 8 | Kaiser fee schedule · outpatient · +7 other terms | 65 | $2.1k | $7.5k | $7.5k | 100% | — | $1.3k – $47.6k |
| 9 | WellCare fee schedule · outpatient · +9 other terms | 59 | $6.4k | $5.8k | $2.1k | 35% | — | $371 – $8.1k |
| 10 | Oscar case rate · outpatient · +12 other terms | 57 | $3.6k | $4.5k | $1.4k | 32% | — | $3.3k – $7.3k |
| 11 | Healthcare Highways case rate · outpatient | 53 | $5.8k | $8.4k | $4.9k | 58% | — | $2.1k – $14.6k |
| 12 | Devoted fee schedule · outpatient · +5 other terms | 48 | $5.6k | $4.6k | $1.9k | 40% | — | $2.1k – $6.6k |
| 13 | Ambetter facility · fee schedule · outpatient · +7 other terms | 45 | $10.1k | $9.9k | $2.1k | 21% | — | $3.0k – $13.4k |
| 14 | Optum fee schedule · outpatient · +6 other terms | 33 | $5.4k | $7.0k | $5.2k | 74% | — | $2.1k – $21.9k |
| 15 | Superior Healthplan case rate · outpatient · +1 other terms | 33 | $948 | $944 | $8 | 1% | — | $929 – $948 |
| 16 | Bcbs Tx fee schedule · outpatient · +2 other terms | 31 | $3.5k | $3.6k | $1.5k | 41% | — | $1.8k – $9.4k |
| 17 | Caresource facility · fee schedule · outpatient · +10 other terms | 30 | $9.1k | $8.5k | $2.6k | 31% | — | $2.2k – $13.1k |
| 18 | Medica case rate · outpatient · +8 other terms | 26 | $3.9k | $4.8k | $2.4k | 49% | — | $1.6k – $10.6k |
| 19 | Regence professional · fee schedule · outpatient · +5 other terms | 20 | $894 | $978 | $763 | 78% | — | $337 – $4.3k |
| 20 | Medicare fee schedule · outpatient · +7 other terms | 18 | $2.1k | $2.0k | $54 | 3% | — | $1.9k – $2.1k |
| 21 | Clover facility · fee schedule · outpatient · +5 other terms | 17 | $5.8k | $6.0k | $323 | 5% | — | $5.5k – $6.4k |
| 22 | Highmark fee schedule · outpatient · +6 other terms | 16 | $2.4k | $3.1k | $2.3k | 75% | — | $1.4k – $17.4k |
| 23 | Medical Mutual facility · fee schedule · outpatient · +4 other terms | 16 | $5.8k | $7.0k | $4.2k | 60% | — | $3.0k – $22.3k |
| 24 | Tricare fee schedule · outpatient · +7 other terms | 16 | $5.8k | $19.5k | $20.6k | 106% | — | $5.4k – $50k |
| 25 | First Health fee schedule · outpatient · +7 other terms | 14 | $9.1k | $10.2k | $5.2k | 51% | — | $2.0k – $16.3k |
← Hospitals reporting CPT 21155 · Snapshot 20261113T090226Z-3ce6c0b8