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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
$2,570.40 / $2,570.40 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,570.40 / $6,025.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,466.84 / $5,623.41 / $6,606.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.30 / $4,786.30 / $7,943.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $3,630.78 / $6,165.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $4,677.35 / $27,542.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $2,041.74 / $11,481.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $4,677.35 / $6,165.95