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Massachusetts 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
$2,570.40 / $3,715.35 / $6,456.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $724.44 / $1,698.24
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $3,981.07 / $13,489.63
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $954.99 / $5,754.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,000.00 / $1,737.80
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $1,288.25 / $7,079.46
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $831.76 / $1,174.90
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $6,165.95 / $13,182.57
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $1,096.48 / $1,621.81
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $3,981.07 / $13,489.63
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $954.99 / $5,754.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $6,165.95 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $954.99 / $1,778.28