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Maine 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
Professional
Modifier
Low / Median / High Price
$1,421.81 / $1,683.03 / $2,193.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,491.08 / $26,019.37 / $30,263.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,774.80 / $2,296.80 / $3,225.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,710.49 / $2,611.09 / $3,712.56
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,106.75 / $2,437.51 / $3,739.27
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,421.81 / $1,683.03 / $2,193.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,606.40 / $2,378.11 / $3,398.23