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Montana rates for HCPCS 21143

Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, without bone graft

Facilitymedian $2,455 · 10th–90th $1,862–$8,3180%50%10th90th$2,455Professionalmedian $2,188 · 10th–90th $1,349–$3,5480%20%10th90th$2,188$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $2,041.74 / $3,801.89
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46,773.51 / $75,857.76 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,187.76 / $2,187.76 / $2,187.76
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,513.56 / $1,819.70 / $2,454.71
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,398.83 / $2,454.71 / $2,691.53
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,398.83 / $2,454.71 / $2,691.53
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,584.89 / $2,089.30 / $2,884.03
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $1,995.26 / $2,884.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,659.59 / $12,022.64
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,513.56 / $2,344.23 / $2,951.21