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Connecticut 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
$4,365.16 / $7,079.46 / $14,125.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $691.83 / $1,905.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $15,135.61 / $16,595.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,288.25 / $1,905.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $851.14 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,122.02 / $1,737.80
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $954.99 / $1,202.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,677.35 / $10,232.93 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $954.99 / $1,778.28