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Connecticut 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
$4,570.88 / $6,025.60 / $10,964.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,754.23 / $7,079.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $15,135.61 / $16,595.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $5,011.87 / $7,079.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $851.14 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,019.95 / $4,897.79 / $7,079.46
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $4,073.80 / $5,011.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,677.35 / $10,232.93 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $3,981.07 / $6,918.31