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Maine rates for HCPCS 21422

Open Treatment Palatal/Maxillary Fracture

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$632.66 / $679.13 / $815.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$653.72 / $845.99 / $1,209.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.21 / $975.40 / $1,361.51
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$790.19 / $914.25 / $1,402.51
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$632.66 / $815.80 / $1,014.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$624.13 / $944.41 / $1,252.15