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North Carolina 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
$1,671.05 / $5,017.00 / $7,968.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,533.57 / $1,753.70 / $4,629.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,807.36 / $3,181.10 / $8,105.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$606.10 / $606.10 / $606.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,685.50 / $2,357.44 / $4,344.67
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,656.00 / $2,104.69 / $3,333.11
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,104.69 / $2,106.00 / $2,190.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.00 / $2,199.69 / $4,378.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,183.00 / $12,216.00 / $19,066.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,453.73 / $2,000.77 / $4,209.49
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $15,574.48 / $15,574.48
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,973.86 / $14,973.86 / $14,973.86