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New Jersey 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
$4,466.84 / $7,413.10 / $11,748.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,630.27 / $7,762.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $3,715.35 / $8,128.31
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $2,818.38 / $3,715.35
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,748.98 / $16,595.87 / $30,902.95
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $3,235.94 / $10,232.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,890.45 / $8,709.64 / $21,379.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,754.23 / $6,456.54