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Utah 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
$3,162.28 / $6,025.60 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $3,235.94 / $13,803.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $3,467.37 / $5,623.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $4,897.79
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $9,772.37 / $21,379.62
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,311.31 / $4,897.79 / $6,456.54
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $4,677.35 / $6,309.57
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $3,981.07 / $6,025.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,818.38 / $4,365.16