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Surgical Repair of a Broken Upper Jaw

Wisconsin rates for HCPCS 21422

Surgery to repair a break running across the upper jaw that separates the tooth-bearing part of the face from the bone above it. The surgeon exposes the fracture, moves the jaw back to its correct position against the rest of the face, and secures it so the teeth meet properly while healing. Restoring the bite is the main aim.

Facilitymedian $10,233 · 10th–90th $1,862$16,9820%5%10%10th90th$10,233Professionalmedian $1,000 · 10th–90th $589$2,8180%10%10th90th$1,000$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
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$1,318.26
Typical High
$14,454.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$630.96
Typical High
$1,584.89
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$6,606.93
Median
$10,964.78
Typical High
$18,197.01
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$1,288.25
Typical High
$3,630.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,621.81
Median
$1,905.46
Typical High
$3,019.95
Cigna
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$2,570.40
Typical High
$2,884.03
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$1,348.96
Typical High
$7,244.36
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$1,122.02
Median
$1,513.56
Typical High
$1,949.84
Medica
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$1,380.38
Typical High
$15,135.61
Medica
Setting
Professional
Modifier
Global
Typical Low
$676.08
Median
$1,258.93
Typical High
$5,623.41
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$70.79
Network Health
Setting
Facility
Modifier
Global
Typical Low
$1,348.96
Median
$9,332.54
Typical High
$15,848.93
Network Health
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$1,584.89
Typical High
$2,754.23
Quartz
Setting
Professional
Modifier
Global
Typical Low
$933.25
Median
$1,412.54
Typical High
$2,089.30
Quartz
Setting
Facility
Modifier
Global
Typical Low
$1,621.81
Median
$4,365.16
Typical High
$4,365.16
Quartz
Setting
Professional
Modifier
Global
Typical Low
$1,122.02
Median
$3,090.30
Typical High
$5,754.40
Security Health
Setting
Professional
Modifier
Global
Typical Low
$2,041.74
Median
$2,041.74
Typical High
$2,041.74
Security Health
Setting
Professional
Modifier
Global
Typical Low
$1,995.26
Median
$3,548.13
Typical High
$3,981.07
United
Setting
Facility
Modifier
Global
Typical Low
$7,585.78
Median
$12,022.64
Typical High
$15,848.93
United
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$1,000.00
Typical High
$2,630.27