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North Dakota 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
$2,582.27 / $2,582.27 / $8,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,574.46 / $2,582.27 / $2,784.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,098.45 / $5,608.54 / $6,576.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,229.49 / $6,233.89 / $8,303.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,582.27 / $3,878.31 / $4,389.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,709.69 / $4,770.13 / $6,689.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.92 / $4,764.70 / $6,689.00