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New York 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
$2,335.77 / $4,648.00 / $10,674.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,335.77 / $2,784.52 / $4,880.91
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,079.00 / $7,359.00 / $12,869.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,128.65 / $2,782.56 / $6,147.96
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,652.03 / $3,652.03 / $37,499.62
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,652.03 / $3,652.03 / $3,652.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,934.56 / $2,934.56 / $2,934.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,503.41 / $4,110.42 / $9,323.50
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.00 / $4,086.00 / $6,671.54
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,995.56 / $4,014.79 / $5,722.70
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,407.53 / $2,407.53 / $2,407.53
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,926.02 / $3,093.44 / $5,456.91
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $597.00 / $2,934.56
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,659.64 / $3,915.91 / $8,776.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,264.00 / $5,963.00 / $14,457.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,296.91 / $3,269.51 / $7,794.58
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,093.44 / $3,093.44 / $13,903.36
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,103.54 / $3,355.13 / $6,539.04