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Oklahoma 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
$1,456.00 / $4,112.00 / $13,200.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.24 / $1,482.58 / $1,482.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,585.95 / $10,462.75 / $16,531.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,362.55 / $1,766.64 / $1,870.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$900.00 / $900.00 / $900.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,480.74 / $1,872.70 / $2,254.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,404.45 / $2,012.00 / $8,753.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,253.61 / $1,601.43 / $13,577.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,481.00 / $5,910.00 / $9,232.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,185.47 / $1,481.85 / $2,090.21