go back

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
$5,011.87 / $7,943.28 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,630.27 / $13,803.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,120.11 / $11,748.98 / $22,908.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $3,890.45 / $5,248.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,754.40 / $5,754.40 / $5,754.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $5,623.41 / $7,413.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $4,168.69 / $8,912.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $4,897.79 / $27,542.29
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,011.87 / $6,025.60 / $7,943.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,754.40 / $5,754.40 / $5,754.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,623.41 / $5,888.44 / $7,943.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,309.57 / $7,413.10 / $9,120.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $4,677.35 / $6,456.54