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Arkansas 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
$812.83 / $1,819.70 / $2,511.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $630.96 / $933.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,165.95 / $6,165.95 / $8,511.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $977.24 / $1,096.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $3,981.07 / $11,748.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $741.31 / $1,174.90