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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
$860.00 / $2,745.39 / $8,229.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,176.53 / $2,502.32 / $3,097.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,720.89 / $10,099.00 / $25,551.65
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,295.48 / $2,703.53 / $3,790.64
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,321.26 / $3,329.98 / $3,841.38
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,378.56 / $3,302.19 / $4,757.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,934.56 / $2,934.56 / $3,050.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,474.44 / $3,757.17 / $5,245.46
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $3,092.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$842.00 / $4,539.00 / $10,113.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,528.14 / $3,604.03 / $5,240.60