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Illinois rates for HCPCS 21422

Open treatment of palatal or maxillary fracture (LeFort I type);

Facilitymedian $4,169 · 10th–90th $1,122–$9,7720%5%10%10th90th$4,169Professionalmedian $794 · 10th–90th $575–$1,5490%10%10th90th$794$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $3,715.35 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $724.44 / $1,479.11
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,760.83 / $8,511.38 / $13,803.84
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,047.13 / $1,288.25
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $891.25 / $1,348.96
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $1,071.52 / $3,801.89
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $794.33 / $870.96
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $660.69
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,570.40 / $5,248.07 / $12,302.69
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $776.25 / $1,318.26