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New Jersey 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
$4,466.84 / $8,511.38 / $12,302.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $660.69 / $2,570.40
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $645.65 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $912.01 / $1,995.26
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $724.44 / $1,000.00
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,022.64 / $19,054.61 / $30,199.52
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $851.14 / $2,570.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,570.88 / $9,120.11 / $21,379.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $676.08 / $1,659.59