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Florida 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
$1,445.44 / $5,495.41 / $10,715.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,630.27 / $4,570.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $398.11 / $4,365.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $3,311.31 / $5,370.32
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,332.54 / $20,892.96 / $33,113.11
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,862.09 / $3,090.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $3,630.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $10,232.93 / $15,848.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,754.23 / $5,011.87
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $2,630.27