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Missouri 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
$1,547.00 / $4,908.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,188.05 / $1,420.60 / $2,260.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,088.00 / $4,247.00 / $9,663.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,354.00 / $1,696.65 / $2,566.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.57 / $1,911.43 / $3,211.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.68 / $1,988.84 / $4,813.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,403.07 / $1,991.89 / $13,577.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,858.00 / $4,000.00 / $11,258.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,350.29 / $1,833.23 / $3,064.13