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Indiana 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
$1,380.38 / $4,897.79 / $14,125.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,630.27 / $4,786.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $19,952.62 / $27,542.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $3,548.13 / $5,495.41
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $2,570.40 / $2,884.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $3,388.44 / $5,754.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $10,000.00 / $18,197.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,884.03 / $5,011.87