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California rates for HCPCS 21421

Closed Tx Palatal/Maxillary Fx W/Fixation/Splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$803.02 / $6,695.00 / $18,252.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531.64 / $670.37 / $3,148.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,675.00 / $8,484.00 / $16,676.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$623.07 / $864.43 / $1,694.37
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.00 / $100.00 / $9,677.87
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$473.00 / $674.86 / $1,521.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,738.49 / $2,743.34 / $4,904.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$604.50 / $865.92 / $1,671.65
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.23 / $745.27 / $1,099.93
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$566.61 / $791.42 / $1,356.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,791.10 / $3,850.56 / $26,542.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,008.16 / $4,721.60 / $5,455.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$653.04 / $815.30 / $1,149.65
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$604.87 / $909.59 / $1,678.04
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,885.34 / $1,885.34 / $2,245.98
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$413.33 / $616.08 / $905.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,523.00 / $7,352.00 / $14,743.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.76 / $728.46 / $1,763.12