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Maine 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
Professional
Modifier
Low / Median / High Price
$1,174.24 / $1,502.84 / $1,824.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,468.05 / $1,899.83 / $2,674.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,421.65 / $2,166.65 / $3,073.30
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,746.49 / $2,020.69 / $3,099.85
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,350.18 / $1,597.24 / $1,824.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,375.77 / $1,926.08 / $2,819.44