go back

Maryland rates for HCPCS 21422

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $676.08 / $1,778.28
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $676.08 / $851.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $512.86 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $831.76 / $1,445.44
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $691.83 / $1,148.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $851.14 / $2,884.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $741.31 / $1,318.26
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $741.31 / $954.99