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North Carolina rates for HCPCS 21422

Open Treatment Palatal/Maxillary Fracture

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$612.14 / $4,759.12 / $10,924.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.14 / $656.46 / $1,218.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$777.33 / $1,054.18 / $1,791.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$606.10 / $606.10 / $606.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$698.21 / $921.03 / $1,662.30
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$612.14 / $816.75 / $1,383.44
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$816.75 / $846.00 / $846.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $828.70 / $1,801.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,183.00 / $12,216.00 / $19,066.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.66 / $813.08 / $1,645.39
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $4,362.54 / $4,362.54
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,358.53 / $5,747.35 / $5,747.35