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Alabama 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
$960.00 / $1,728.00 / $2,639.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,181.69 / $2,596.80 / $4,167.39
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,931.14 / $7,197.72 / $9,683.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,562.30 / $3,510.00 / $4,292.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,207.50 / $3,016.16 / $8,675.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,074.00 / $3,816.00 / $7,227.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,018.94 / $2,557.32 / $4,584.56