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Idaho rates for HCPCS 21143

Rcnstj Midface Lefort I 3/> Piece W/O Bone Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,422.00 / $4,500.00 / $8,622.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.60 / $2,085.96 / $2,929.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,597.11 / $2,151.73 / $2,728.40
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,352.45 / $2,492.17 / $3,545.18
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,261.36 / $2,466.94 / $3,344.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $1,978.00 / $2,488.44
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,662.17 / $14,534.58 / $18,446.52
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,287.23 / $2,801.97 / $3,344.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,100.00 / $10,120.00 / $27,159.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,560.27 / $2,011.94 / $3,009.69