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New Jersey 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
$4,466.84 / $7,585.78 / $11,748.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,737.80 / $6,456.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $2,344.23 / $5,370.32
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,862.09 / $2,570.40
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,748.98 / $16,595.87 / $30,902.95
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,137.96 / $6,918.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,890.45 / $8,709.64 / $21,379.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,698.24 / $4,168.69