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Pennsylvania rates for HCPCS 21348

Open treatment of nasomaxillary complex fracture (LeFort II type); with bone grafting (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,126.53 / $4,048.00 / $8,451.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$986.56 / $1,101.61 / $1,596.69
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,296.00
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,091.93 / $1,133.13 / $1,133.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,243.70 / $1,243.70 / $1,243.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,039.93 / $1,372.99 / $2,226.94
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,275.01 / $1,707.89 / $2,202.29
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,126.53 / $4,993.00 / $10,247.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$997.86 / $1,215.60 / $5,371.61
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,273.70 / $1,273.70 / $2,437.10
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,243.70 / $1,243.70 / $1,243.70
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,042.29 / $1,390.66 / $2,331.75
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,074.54 / $1,074.54 / $1,235.68
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,042.68 / $1,078.61 / $1,235.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,332.00 / $3,879.00 / $7,508.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.43 / $1,310.96 / $2,156.92