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Pennsylvania 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
$1,020.00 / $4,048.00 / $8,451.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.55 / $626.91 / $946.38
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,296.00
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$631.07 / $654.89 / $654.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$713.09 / $713.09 / $713.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$595.35 / $795.21 / $1,273.34
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$743.06 / $995.12 / $1,283.47
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,110.69 / $9,110.69 / $9,110.69
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,054.00 / $4,993.00 / $10,247.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.10 / $695.04 / $3,102.62
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$747.10 / $747.10 / $1,392.10
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$713.09 / $713.09 / $713.09
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.71 / $803.65 / $1,333.96
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$614.73 / $614.73 / $753.12
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.01 / $614.73 / $753.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,332.00 / $3,879.00 / $7,508.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$594.37 / $772.68 / $1,201.24