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New York 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
$1,010.88 / $4,629.00 / $10,674.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$718.59 / $839.31 / $1,404.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,079.00 / $7,359.00 / $12,869.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$703.87 / $894.14 / $1,958.94
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,143.64 / $1,143.64 / $37,499.62
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,143.64 / $1,143.64 / $1,143.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$895.74 / $895.74 / $895.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$792.92 / $1,250.98 / $2,939.81
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.00 / $1,057.00 / $2,098.89
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$865.44 / $1,220.58 / $1,800.38
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$743.18 / $743.18 / $743.18
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$670.50 / $947.68 / $1,676.88
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $597.00 / $895.74
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.17 / $1,169.40 / $2,841.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,264.00 / $5,963.00 / $14,457.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$684.56 / $976.95 / $2,382.21
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$950.60 / $950.60 / $3,692.83
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$670.50 / $988.62 / $2,009.41