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Arizona 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
$2,089.30 / $4,677.35 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $707.95 / $2,137.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $2,511.89 / $3,801.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $851.14 / $1,548.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $758.58 / $1,318.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $758.58 / $3,801.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $912.01 / $4,786.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $3,311.31 / $5,370.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $691.83 / $1,148.15