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Idaho 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
$3,388.44 / $4,466.84 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $812.83 / $1,348.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $3,890.45 / $9,772.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,096.48 / $1,288.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $1,659.59 / $1,659.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $891.25 / $1,148.15
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $977.24 / $1,659.59
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,148.15 / $1,348.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,754.40 / $7,585.78 / $10,232.93
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,122.02 / $1,412.54
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $1,000.00 / $7,585.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $5,495.41 / $12,302.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $954.99 / $1,412.54