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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
$776.25 / $776.25 / $2,290.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $794.33 / $1,737.80
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $831.76 / $1,023.29
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $891.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $1,348.96 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,174.90 / $6,760.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $16,595.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $891.25 / $1,258.93