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West Virginia 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
$1,400.00 / $2,556.16 / $3,919.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,528.56 / $2,659.19 / $3,919.80
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,729.40 / $3,035.52 / $3,307.24
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,508.32 / $2,939.77 / $2,939.77
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
$2,494.63 / $3,905.09 / $6,941.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,090.13 / $3,219.67 / $4,688.92