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Alaska rates for HCPCS 21422

Open Treatment Palatal/Maxillary Fracture

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,236.00 / $9,813.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.10 / $3,084.93 / $3,084.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,580.49 / $2,115.35 / $2,710.92
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$595.35 / $3,084.93 / $4,318.89
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,550.20 / $1,860.24 / $3,776.49
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,371.25 / $3,173.40 / $3,888.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$595.35 / $3,084.93 / $4,318.89
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$932.11 / $3,110.25 / $4,248.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,692.28 / $2,552.98 / $3,723.02