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West Virginia 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
$606.45 / $948.29 / $2,600.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$606.45 / $656.46 / $1,333.53
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$611.98 / $665.56 / $800.12
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.83 / $711.22 / $711.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$713.09 / $713.09 / $713.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.71 / $925.48 / $1,891.32
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30,798.96 / $30,798.96 / $30,798.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.27 / $764.41 / $1,106.03