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Minnesota rates for HCPCS 21422

Open Treatment Palatal/Maxillary Fracture

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$636.35 / $636.35 / $6,781.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$624.82 / $636.35 / $1,001.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,040.89 / $10,115.75 / $20,811.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,091.25 / $1,748.44 / $2,281.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,525.40 / $2,164.32 / $5,206.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,158.60 / $1,845.65 / $2,741.07
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,386.72 / $1,978.70 / $4,099.64
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,048.97 / $1,650.13 / $2,513.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.34 / $1,108.10 / $4,273.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$732.44 / $1,305.73 / $2,585.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,940.00 / $7,872.00 / $11,531.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$717.76 / $1,271.07 / $2,430.35