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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
$581.10 / $656.46 / $1,711.01
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$680.34 / $680.34 / $950.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.00 / $507.00 / $641.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.71 / $869.13 / $1,487.09
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.49 / $853.32 / $1,120.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$847.00 / $847.00 / $1,560.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$518.71 / $733.62 / $1,365.92
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$633.22 / $760.71 / $940.68