go back

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
$6,025.60 / $6,025.60 / $7,244.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,691.53 / $6,456.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,691.53 / $4,786.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $2,511.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $3,090.30 / $4,897.79