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Maine 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
Professional
Modifier
Low / Median / High Price
$2,238.72 / $3,090.30 / $6,760.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $3,801.89 / $5,495.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.03 / $3,801.89 / $5,754.40
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,754.23 / $3,388.44 / $6,165.95
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $3,630.78 / $7,762.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $3,311.31 / $5,128.61