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New Mexico 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
$1,000.00 / $2,643.25 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,333.07 / $2,643.25 / $8,802.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,409.15 / $3,895.56 / $4,683.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $4,008.41
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,459.15 / $3,632.54 / $6,216.70
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,747.78 / $4,121.66 / $6,351.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$899.00 / $11,259.00 / $16,897.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,014.34 / $3,749.52 / $5,293.46