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Alaska rates for HCPCS 21421

Closed treatment of palatal or maxillary fracture (LeFort I type), with interdental wire fixation or fixation of denture or splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $9,772.37 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $812.83 / $1,819.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,819.70 / $2,818.38
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $1,122.02 / $3,630.78
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,995.26 / $3,090.30
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,630.27 / $3,981.07
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $891.25 / $3,388.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $954.99 / $1,819.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $2,570.40 / $3,715.35