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Alaska rates for HCPCS 21142

Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, without bone graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,000.44 / $9,774.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,198.75 / $1,399.83 / $6,784.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,427.10 / $4,608.85 / $5,885.97
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,280.44 / $6,784.88 / $9,498.83
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,324.40 / $3,989.28 / $8,098.67
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,070.00 / $6,799.16 / $8,338.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,280.44 / $6,784.88 / $9,498.83
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,059.92 / $6,720.10 / $8,868.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,687.08 / $7,374.16 / $8,111.58