go back

Alaska rates for HCPCS 21147

Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted bilateral alveolar cleft or multiple osteotomies)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,305.62 / $9,577.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.12 / $8,501.54 / $8,501.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,297.13 / $5,796.30 / $7,323.53
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,594.87 / $8,501.54 / $11,902.16
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,133.08 / $4,959.68 / $10,068.67
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,355.00 / $8,500.24 / $10,400.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,594.87 / $8,501.54 / $11,902.16
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,580.01 / $8,385.29 / $11,127.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,637.04 / $9,274.08 / $10,201.49