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New York 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
$1,548.00 / $4,827.00 / $10,930.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,207.86 / $1,395.83 / $3,448.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,046.00 / $7,417.00 / $18,161.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,110.23 / $1,451.29 / $3,220.71
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,892.87 / $1,892.87 / $10,957.50
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,892.87 / $1,892.87 / $1,892.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,491.55 / $1,491.55 / $1,491.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,286.93 / $2,094.82 / $4,904.29
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.00 / $1,656.00 / $3,409.36
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,453.33 / $1,995.99 / $2,924.47
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,248.03 / $1,248.03 / $1,248.03
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,094.25 / $1,593.00 / $2,810.09
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $597.00 / $1,491.55
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,355.24 / $2,002.53 / $4,681.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,264.00 / $5,963.00 / $14,457.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,157.65 / $1,671.45 / $3,981.73
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,593.00 / $1,593.00 / $6,004.12
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,125.23 / $1,739.26 / $3,367.35