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Iowa 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
$870.96 / $4,570.88 / $7,079.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $676.08 / $1,659.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,513.56 / $1,949.84
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $794.33 / $2,290.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $1,479.11 / $7,244.36
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,412.54 / $4,073.80
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,412.54 / $1,737.80
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,548.82 / $1,737.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,365.16 / $6,606.93 / $8,912.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $891.25 / $1,778.28
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,258.93 / $1,479.11