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Ohio 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
$1,925.00 / $6,075.00 / $11,627.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.24 / $1,380.51 / $3,526.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,003.00 / $4,426.00 / $19,117.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,119.95 / $1,712.26 / $4,423.52
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,231.95 / $1,343.94 / $1,956.97
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,375.49 / $1,449.35 / $1,844.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.26 / $1,853.66 / $2,736.07
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,579.28 / $1,579.28 / $1,579.28
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,383.47 / $1,978.67 / $2,660.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.74 / $971.46 / $1,642.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,206.00 / $6,231.00 / $10,075.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,111.38 / $1,746.39 / $2,848.34