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Kentucky 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
$851.14 / $2,818.38 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,570.40 / $5,370.32
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,511.38 / $10,715.19 / $11,220.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,754.23 / $3,890.45
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $3,235.94 / $4,168.69
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $3,090.30 / $3,801.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $4,365.16 / $4,365.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.03 / $4,466.84 / $16,218.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $2,187.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $4,677.35 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $3,311.31 / $5,248.07