go back

Arizona 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
$1,965.00 / $4,474.00 / $7,960.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,189.57 / $2,557.92 / $13,574.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,763.75 / $6,640.00 / $10,860.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,665.61 / $3,046.41 / $3,808.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,300.30 / $3,190.84 / $5,195.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,455.87 / $3,365.45 / $7,168.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,292.46 / $2,939.24 / $27,619.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,613.00 / $6,455.00 / $9,010.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,243.17 / $2,655.89 / $4,946.10