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North Dakota 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
$1,738.01 / $1,738.01 / $8,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,421.81 / $1,683.03 / $1,738.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,354.01 / $3,696.84 / $4,334.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,102.71 / $4,200.93 / $5,595.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,738.01 / $2,066.54 / $2,954.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,783.55 / $3,123.43 / $4,524.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,783.55 / $3,156.88 / $4,524.10