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New Hampshire 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
$2,398.83 / $2,398.83 / $15,848.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $741.31 / $1,621.81
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $5,623.41 / $8,912.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $1,202.26 / $1,698.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,096.48 / $1,905.46
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,220.18 / $11,220.18 / $11,220.18
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,023.29 / $1,548.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,220.18 / $11,220.18 / $11,220.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $977.24 / $1,737.80
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $478.63 / $758.58