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Arkansas 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
$1,513.56 / $1,995.26 / $3,801.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,630.27 / $3,981.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $4,073.80 / $4,570.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $4,073.80 / $11,748.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $3,090.30 / $4,786.30