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Georgia 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
$3,890.45 / $5,623.41 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,818.38 / $5,754.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $3,801.89 / $6,918.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $4,265.80 / $5,754.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $2,511.89 / $4,365.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,754.23 / $4,073.80 / $6,606.93
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $3,630.78 / $14,125.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $6,918.31 / $12,022.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $3,715.35 / $5,754.40