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Alaska rates for HCPCS 21143

Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, without bone graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,125.52 / $9,774.00 / $14,772.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,308.82 / $6,997.05 / $6,997.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,548.70 / $4,786.84 / $6,063.05
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,320.04 / $6,997.05 / $9,795.87
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,426.30 / $4,111.56 / $8,346.89
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,290.00 / $7,062.32 / $8,460.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,320.04 / $6,997.05 / $9,795.87
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,125.23 / $6,938.25 / $9,306.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,829.46 / $6,701.56 / $8,424.81