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Illinois rates for HCPCS 21421

Closed Tx Palatal/Maxillary Fx W/Fixation/Splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$755.00 / $2,228.00 / $5,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$492.00 / $626.41 / $1,206.22
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,887.73 / $6,037.62 / $12,413.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$631.95 / $1,027.08 / $1,266.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.00 / $2,713.32 / $3,029.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531.41 / $844.35 / $1,358.07
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.73 / $948.39 / $2,818.88
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.17 / $669.37 / $862.06
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $994.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,499.00 / $3,951.00 / $7,295.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$644.45 / $902.09 / $1,505.86