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Washington, DC 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
$2,137.96 / $5,128.61 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,630.27 / $7,762.47
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $3,890.45 / $10,715.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $4,168.69 / $7,079.46
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $5,248.07 / $5,888.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $16,218.10 / $33,884.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $3,388.44 / $7,079.46