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Missouri 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
$1,760.00 / $5,389.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,188.46 / $2,619.64 / $4,128.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,224.00 / $4,490.00 / $12,405.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,594.19 / $3,313.96 / $5,104.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,575.96 / $3,633.68 / $5,724.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,188.46 / $3,797.00 / $6,980.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,530.63 / $3,744.69 / $27,619.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,858.00 / $4,000.00 / $11,258.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,476.57 / $3,423.89 / $5,706.63