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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
$590.97 / $4,846.00 / $30,764.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$561.53 / $599.37 / $799.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,852.40 / $10,338.00 / $26,304.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.12 / $811.40 / $1,119.73
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.92 / $748.71 / $863.90
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.92 / $691.12 / $863.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$641.50 / $800.99 / $1,379.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,472.00 / $10,113.00 / $15,750.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.54 / $706.54 / $1,290.20