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Indiana rates for HCPCS 21423

Open treatment of palatal or maxillary fracture (LeFort I type); complicated (comminuted or involving cranial nerve foramina), multiple approaches

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$742.51 / $1,908.25 / $14,063.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$711.03 / $764.80 / $1,002.39
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,838.00 / $17,380.30 / $25,253.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$673.38 / $948.30 / $1,308.65
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$717.54 / $932.80 / $1,076.31
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$717.54 / $861.05 / $1,076.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$768.49 / $983.17 / $1,650.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,472.00 / $10,113.00 / $15,750.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.01 / $862.12 / $1,530.81