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Delaware 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
$5,816.00 / $5,816.00 / $6,907.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.23 / $2,580.96 / $2,580.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,252.80 / $2,684.96 / $4,725.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,530.00 / $2,530.00 / $2,530.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,182.56 / $3,299.00 / $5,895.32