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Washington, DC 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
$691.83 / $5,128.61 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $645.65 / $1,778.28
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $3,548.13 / $8,128.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $912.01 / $1,862.09
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,258.93 / $1,513.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $13,803.84 / $26,302.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $851.14 / $1,737.80