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Alaska rates for HCPCS 21422

Open treatment of palatal or maxillary fracture (LeFort I type);

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.09 / $10,000.00 / $20,417.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $812.83 / $1,862.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $2,137.96 / $2,691.53
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $1,230.27 / $4,365.16
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,187.76 / $3,311.31
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,570.40 / $3,890.45
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $1,122.02 / $3,388.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $891.25 / $2,137.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $2,884.03 / $3,715.35