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Ohio rates for HCPCS 21422

Open treatment of palatal or maxillary fracture (LeFort I type);

Facilitymedian $6,310 · 10th–90th $1,202$12,0230%10%10th90th$6,310Professionalmedian $741 · 10th–90th $575$1,7780%20%10th90th$741$10.0$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $7,585.78 / $12,022.64
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $691.83 / $6,165.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,238.72 / $4,365.16 / $16,982.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $758.58 / $1,174.90
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$602.56 / $602.56 / $707.95
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21,379.62 / $21,379.62 / $21,379.62
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $870.96 / $1,258.93
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21,379.62 / $21,379.62 / $21,379.62
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $831.76 / $1,258.93
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $123.03
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $7,244.36
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $691.83 / $1,318.26
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,290.87 / $6,025.60 / $13,489.63
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $724.44 / $1,122.02