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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
$4,365.16 / $4,466.84 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $831.76 / $1,288.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $6,606.93 / $15,135.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,230.27 / $1,258.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $891.25 / $1,148.15
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $1,096.48 / $1,737.80
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,122.02 / $1,479.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,772.37 / $13,182.57 / $18,620.87
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,230.27 / $1,513.56
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $676.08 / $9,332.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $10,232.93 / $27,542.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $954.99 / $1,380.38