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Wyoming 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
$2,557.92 / $2,614.34 / $3,254.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,946.00 / $5,935.00 / $8,978.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,254.73 / $4,882.09 / $7,149.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,188.00 / $5,188.00 / $18,767.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,225.89 / $5,195.41 / $9,262.46