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Georgia 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
$1,064.51 / $5,063.00 / $7,391.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$573.64 / $691.34 / $1,461.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,240.00 / $3,931.95 / $8,545.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$618.16 / $931.00 / $1,599.33
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,027.32 / $1,027.32 / $1,027.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.00 / $713.09 / $2,500.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$682.94 / $1,043.31 / $1,596.18
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$686.85 / $1,055.25 / $1,812.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,738.00 / $7,794.00 / $14,048.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$565.97 / $893.85 / $1,441.69