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Nebraska 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
$4,241.22 / $10,431.19 / $20,928.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,386.76 / $2,386.76 / $13,574.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,086.90 / $11,951.75 / $23,118.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.27 / $3,903.88 / $5,205.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,616.00 / $5,755.21 / $7,852.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,386.76 / $4,176.83 / $7,990.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,190.29 / $5,245.84 / $7,160.58
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,106.53 / $5,931.11 / $7,979.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,446.09 / $5,643.34 / $7,852.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,178.00 / $7,441.00 / $8,816.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,190.29 / $5,245.84 / $6,835.20