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Arizona rates for HCPCS 21141

Reconstruction midface, LeFort I; single piece, segment movement in any direction (eg, for Long Face Syndrome), without bone graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,705.00 / $4,474.00 / $8,239.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,140.67 / $1,262.00 / $2,153.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,763.75 / $6,640.00 / $10,860.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,381.89 / $1,579.30 / $1,974.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,156.57 / $1,565.60 / $2,699.14
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,271.44 / $1,719.22 / $7,168.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,166.22 / $1,461.48 / $12,480.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,613.00 / $6,455.00 / $9,010.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,155.24 / $1,346.11 / $2,545.30