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Colorado 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
$977.24 / $5,248.07 / $10,715.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $676.08 / $1,621.81
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $11,481.54 / $23,988.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $912.01 / $1,412.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,071.52 / $1,071.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $870.96 / $1,380.38
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $851.14 / $3,388.44
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $602.56 / $1,174.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,511.38 / $12,022.64 / $18,620.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $891.25 / $1,584.89