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Pennsylvania rates for HCPCS 21142

Rcnstj Midface Lefort I 2 Pieces W/O Bone Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,404.09 / $4,051.00 / $9,211.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,198.75 / $1,350.29 / $1,984.68
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,296.00
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,357.27 / $1,408.48 / $2,561.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,531.60 / $1,531.60 / $1,531.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,219.63 / $1,671.79 / $2,728.36
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,586.50 / $2,105.16 / $2,740.31
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,535.99 / $14,850.26 / $33,381.76
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,283.00 / $4,831.00 / $9,436.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,229.60 / $1,426.00 / $4,170.14
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,432.50 / $1,432.50 / $2,880.50
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,531.60 / $1,531.60 / $1,531.60
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,222.91 / $1,699.69 / $2,787.82
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,334.78 / $1,334.78 / $1,426.03
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,302.84 / $1,334.78 / $1,426.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,332.00 / $3,879.00 / $7,508.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,212.63 / $1,592.07 / $2,569.96