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Minnesota rates for HCPCS 21422

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $630.96 / $6,606.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $645.65 / $1,288.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,890.45 / $11,748.98 / $26,915.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,513.56 / $2,290.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $2,290.87 / $5,495.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,862.09 / $2,818.38
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $2,238.72 / $4,265.80
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,584.89 / $2,511.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $1,258.93 / $9,772.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $1,230.27 / $3,548.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,168.69 / $7,943.28 / $12,589.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $1,202.26 / $2,290.87