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Massachusetts 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
$2,238.72 / $3,630.78 / $5,623.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,951.21 / $6,760.83
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $6,165.95 / $16,595.87
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $4,073.80 / $27,542.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $3,981.07 / $7,079.46
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $3,388.44 / $8,511.38
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $3,090.30 / $4,265.80
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $6,165.95 / $13,182.57
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $4,168.69 / $6,025.60
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $6,165.95 / $16,595.87
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $4,073.80 / $27,542.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $6,309.57 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $3,981.07 / $6,918.31