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Indiana 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
$954.99 / $10,471.29 / $30,902.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $630.96 / $1,380.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $19,952.62 / $27,542.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $812.83 / $1,318.26
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $630.96 / $724.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $812.83 / $1,380.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $9,549.93 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $707.95 / $1,258.93