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Nebraska rates for HCPCS 21422

Open Treatment Palatal/Maxillary Fracture

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,241.22 / $10,431.19 / $21,899.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$583.40 / $583.40 / $3,084.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,086.90 / $11,951.75 / $23,118.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$558.29 / $947.71 / $1,268.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,016.00 / $1,439.82 / $1,928.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$583.40 / $1,020.95 / $7,363.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$790.61 / $1,307.54 / $1,818.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.83 / $1,439.82 / $1,931.33
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,082.00 / $1,361.29 / $1,928.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,178.00 / $7,441.00 / $8,816.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$790.61 / $1,307.54 / $1,702.85