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Ohio 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
$2,502.32 / $7,342.00 / $11,627.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,189.57 / $2,556.16 / $6,556.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,142.00 / $14,428.74 / $24,745.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,298.00 / $3,175.57 / $5,335.26
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,275.58 / $2,482.44 / $3,614.80
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,677.16 / $2,677.16 / $3,407.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,516.83 / $3,577.66 / $5,028.77
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,934.56 / $2,934.56 / $2,934.56
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,555.46 / $3,678.41 / $5,102.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.88 / $1,770.20 / $3,007.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,206.00 / $6,231.00 / $10,075.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,153.54 / $3,328.71 / $5,342.26