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Minnesota 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
$1,737.80 / $1,737.80 / $6,760.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,737.80 / $3,235.94
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $6,025.60 / $14,125.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $3,981.07 / $6,165.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,365.16 / $6,165.95 / $14,791.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,019.95 / $5,011.87 / $7,585.78
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,786.30 / $6,025.60 / $11,748.98
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,235.94 / $4,265.80 / $6,760.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $3,235.94 / $5,370.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $3,162.28 / $9,549.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $5,754.40 / $12,589.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $3,019.95 / $6,165.95