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Nebraska 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
$5,754.40 / $7,943.28 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $630.96 / $3,467.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,120.11 / $11,748.98 / $22,908.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $977.24 / $1,380.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,888.44 / $5,888.44 / $5,888.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,412.54 / $1,862.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $1,047.13 / $8,709.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,230.27 / $5,623.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,513.56 / $1,949.84
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,888.44 / $5,888.44 / $5,888.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,445.44 / $1,949.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,309.57 / $7,413.10 / $9,120.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,148.15 / $1,698.24