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Idaho 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
$3,388.44 / $4,466.84 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $3,235.94 / $5,370.32
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,165.95 / $9,120.11 / $11,748.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,265.80 / $4,897.79 / $5,128.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $3,388.44 / $4,570.88
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $4,168.69 / $6,606.93
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,630.78 / $4,168.69 / $5,495.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,165.95 / $7,585.78 / $10,232.93
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,548.13 / $5,011.87 / $5,370.32
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,238.72 / $5,495.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $10,232.93 / $27,542.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $3,801.89 / $5,248.07