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
Folsom, CA
See all hospitals reporting CPT 21155 →Price type
Dignity Health’s median price of $7.5k is 20% above the median hospital's median price ($6.3k), higher than 65% of the 1,324 hospitals reporting CPT 21155. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 5 payers, 17 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | UnitedHealthcare medicaid|< 21 fee schedule · outpatient | $1.3k | $1.3k | — | — | — | $1.3k – $1.3k |
| 2 | UnitedHealthcare medicaid|> 21 fee schedule · outpatient | $1.3k | $1.3k | — | — | — | $1.3k – $1.3k |
| 3 | Anthem medicaid|all plans fee schedule · outpatient | $3.0k | $3.0k | — | — | — | $3.0k – $3.0k |
| 4 | Molina medicaid|all plans fee schedule · outpatient | $3.7k | $3.7k | — | — | — | $3.7k – $3.7k |
| 5 | Blue Cross Blue Shield commercial|aco trio case rate · outpatient | $6.0k | $6.0k | — | — | — | $6.0k – $6.0k |
| 6 | Blue Cross Blue Shield commercial|exchange case rate · outpatient | $7.5k | $7.5k | — | — | — | $7.5k – $7.5k |
| 7 | Blue Cross Blue Shield commercial|aco trio calpers case rate · outpatient | $7.6k | $7.6k | — | — | — | $7.6k – $7.6k |
| 8 | Blue Cross Blue Shield commercial|ppo tandem case rate · outpatient | $11.0k | $11.0k | — | — | — | $11.0k – $11.0k |
| 9 | Blue Cross Blue Shield commercial|hmo case rate · outpatient | $11.1k | $11.1k | — | — | — | $11.1k – $11.1k |
| 10 | Aetna commercial|all other plans case rate · outpatient | $11.4k | $11.4k | — | — | — | $11.4k – $11.4k |
| 11 | Aetna commercial|hmo case rate · outpatient | $11.4k | $11.4k | — | — | — | $11.4k – $11.4k |
| 12 | Aetna commercial|ppo case rate · outpatient | $11.4k | $11.4k | — | — | — | $11.4k – $11.4k |
| 13 | Blue Cross Blue Shield commercial|calpers case rate · outpatient | $11.8k | $11.8k | — | — | — | $11.8k – $11.8k |
| 14 | Anthem commercial|connection epo case rate · outpatient | $12.6k | $12.6k | — | — | — | $12.6k – $12.6k |
| 15 | Blue Cross Blue Shield commercial|all other plans case rate · outpatient | $13.1k | $13.1k | — | — | — | $13.1k – $13.1k |
| 16 | Anthem commercial|all other plans case rate · outpatient | $15.8k | $15.8k | — | — | — | $15.8k – $15.8k |
| 17 | Anthem commercial|mcs case rate · outpatient | $22.1k | $22.1k | — | — | — | $22.1k – $22.1k |
Last updated: Feb 28, 2026
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