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Massachusetts 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
$1,949.84 / $3,630.78 / $5,623.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,659.59 / $3,801.89
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $4,677.35 / $13,489.63
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $2,137.96 / $13,489.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $2,187.76 / $3,890.45
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $2,137.96 / $7,079.46
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,778.28 / $2,511.89
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $6,165.95 / $13,182.57
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $2,344.23 / $3,467.37
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $4,677.35 / $13,489.63
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $2,137.96 / $13,489.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $6,309.57 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,089.30 / $3,981.07