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Hawaii 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
$1,924.00 / $2,747.00 / $5,484.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,899.31 / $2,899.31 / $2,899.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,510.76 / $3,193.84 / $3,832.61
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,394.34 / $3,813.64 / $4,434.46
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,810.58 / $3,066.08 / $3,577.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $2,912.00 / $2,912.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,606.17 / $3,193.84 / $4,137.35
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.27 / $2,319.57 / $5,099.05