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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
$2,187.76 / $4,265.80 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,754.23 / $6,760.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $4,677.35 / $8,912.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $3,311.31 / $5,128.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,691.53 / $3,630.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $3,548.13 / $5,370.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $3,801.89 / $7,585.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $3,630.78 / $27,542.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $3,311.31 / $7,943.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $3,162.28 / $4,897.79