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Missouri 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
$1,760.00 / $5,389.00 / $9,823.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531.69 / $635.55 / $1,004.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,088.00 / $4,247.00 / $9,663.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$629.54 / $784.67 / $1,233.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$628.02 / $872.62 / $1,421.42
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$580.01 / $997.07 / $4,393.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$634.72 / $893.15 / $5,563.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,156.00 / $4,000.00 / $10,781.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.27 / $832.31 / $1,375.02