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Hawaii 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
$1,949.84 / $5,495.41 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $691.83 / $954.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $851.14 / $1,096.48
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,122.02 / $4,365.16
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $776.25 / $1,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $724.44 / $1,096.48
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $3,162.28 / $7,585.78