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Rhode Island 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
$2,993.72 / $3,706.14 / $3,955.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,237.05 / $3,317.88 / $3,919.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,209.13 / $3,057.62 / $4,813.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,185.02 / $4,420.60 / $5,333.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,219.00 / $7,228.00 / $12,680.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,120.84 / $3,523.58 / $4,896.68