go back

Idaho 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
$4,415.00 / $4,500.00 / $8,439.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$644.85 / $934.69 / $1,289.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$715.35 / $953.80 / $1,151.66
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$609.44 / $1,216.41 / $1,559.96
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.13 / $1,116.14 / $1,484.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $884.74 / $1,113.06
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,662.17 / $14,534.58 / $18,446.52
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,062.24 / $1,249.69 / $1,484.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,100.00 / $10,120.00 / $27,159.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$701.09 / $1,014.45 / $1,370.05