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Vermont 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
Professional
Modifier
Low / Median / High Price
$2,238.72 / $3,311.31 / $6,456.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $3,630.78 / $5,754.40
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $3,548.13 / $4,265.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,019.95 / $3,630.78 / $6,025.60