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New Hampshire 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
$100.00 / $2,331.21 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$722.43 / $839.31 / $1,248.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,299.00 / $16,696.31 / $29,108.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$778.90 / $1,335.67 / $1,990.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$895.74 / $895.74 / $895.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.17 / $1,510.60 / $2,360.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.68 / $1,462.89 / $2,752.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,155.00 / $11,155.00 / $11,155.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$883.79 / $1,205.10 / $2,303.10
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$605.26 / $665.79 / $847.36