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Arizona 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
$1,231.61 / $4,474.00 / $7,960.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.53 / $624.82 / $1,457.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,763.75 / $6,640.00 / $10,860.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.83 / $754.09 / $942.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$561.13 / $776.98 / $1,270.11
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$606.71 / $831.55 / $6,950.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$571.95 / $710.15 / $5,563.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,637.00 / $6,477.00 / $9,010.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$571.55 / $664.20 / $1,252.84