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Missouri 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
$1,547.00 / $4,908.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,123.57 / $1,343.34 / $2,153.48
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,088.00 / $4,247.00 / $9,663.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,308.00 / $1,600.81 / $2,525.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,257.36 / $1,803.29 / $3,031.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,108.34 / $1,880.68 / $4,813.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,319.84 / $1,884.25 / $12,480.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,858.00 / $4,000.00 / $11,258.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,276.97 / $1,746.66 / $2,869.60