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California 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
$2,421.00 / $8,870.00 / $19,368.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$558.33 / $626.91 / $3,402.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,028.00 / $9,447.00 / $18,544.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$748.30 / $954.90 / $1,846.02
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.40 / $100.00 / $5,714.18
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.29 / $774.24 / $1,694.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,277.00 / $2,277.00 / $2,277.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.86 / $823.65 / $1,822.59
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.46 / $739.18 / $933.41
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$609.22 / $830.34 / $1,534.01
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $3,521.70 / $4,393.14
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,358.53 / $5,563.75 / $5,747.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.91 / $879.98 / $1,267.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.21 / $866.16 / $1,732.39
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,111.40 / $2,111.40 / $2,111.40
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$603.08 / $732.69 / $923.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,142.00 / $12,377.00 / $26,451.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$516.60 / $678.28 / $1,578.45