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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
$1,924.00 / $2,747.00 / $5,039.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,303.00 / $1,392.80 / $2,256.81
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,544.59 / $4,751.20 / $12,912.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,353.13 / $2,408.10 / $13,577.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,421.65 / $2,266.02 / $4,102.00
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,405.82 / $2,271.00 / $6,679.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,613.18 / $1,954.09 / $2,664.64
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,735.48 / $3,283.70 / $4,322.39
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $5,063.00 / $12,912.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,515.36 / $2,582.64 / $13,577.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,324.00 / $5,097.00 / $10,764.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,431.55 / $2,127.28 / $4,093.16