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Maine 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
$575.44 / $741.31 / $1,778.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $933.25 / $1,412.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $933.25 / $1,412.54
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $870.96 / $1,659.59
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $870.96 / $1,905.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $851.14 / $1,288.25