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Alaska rates for HCPCS 21159

Reconstruction midface, LeFort III (extra and intracranial) with forehead advancement (eg, mono bloc), requiring bone grafts (includes obtaining autografts); without LeFort I

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,820.00 / $9,774.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,412.78 / $12,955.16 / $12,955.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,506.42 / $8,767.50 / $11,083.78
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,426.51 / $12,955.16 / $18,137.22
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,270.38 / $7,524.45 / $15,275.38
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,386.25 / $12,680.30 / $15,492.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,426.51 / $12,955.16 / $18,137.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,943.93 / $12,663.00 / $16,451.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,613.38 / $10,581.36 / $15,430.80