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Rhode Island 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
$3,019.95 / $3,715.35 / $3,981.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,737.80 / $4,570.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,737.80 / $2,818.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,290.87 / $3,548.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $7,413.10 / $13,182.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,089.30 / $3,715.35