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West Virginia 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
$781.33 / $1,200.02 / $2,300.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$717.27 / $834.74 / $1,186.33
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$774.44 / $836.03 / $1,012.51
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.82 / $900.01 / $900.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$895.74 / $895.74 / $895.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$765.27 / $1,140.11 / $2,236.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$607.36 / $903.45 / $1,259.65