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Colorado 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
$1,699.56 / $6,845.00 / $26,090.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,421.81 / $1,699.56 / $2,428.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,946.00 / $9,834.00 / $18,248.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,839.22 / $2,408.17 / $3,861.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,726.01 / $2,290.07 / $3,429.97
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,699.56 / $2,183.25 / $2,964.67
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,851.00 / $2,439.96 / $3,365.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,251.00 / $11,924.00 / $19,712.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,770.39 / $2,430.23 / $3,851.93