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Pennsylvania 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
$1,288.25 / $5,370.32 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $831.76 / $2,041.74
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,417.38 / $21,379.62 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,122.02 / $1,230.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $954.99 / $1,584.89
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,148.15 / $1,479.11
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $954.99 / $1,548.82
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35,481.34 / $35,481.34 / $35,481.34
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $4,570.88 / $8,511.38
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,071.52 / $2,238.72
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,621.81
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,071.52 / $1,778.28
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $831.76 / $851.14
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $831.76 / $851.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $4,365.16 / $18,197.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $891.25 / $1,479.11