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Illinois 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
$851.14 / $3,235.94 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $707.95 / $1,380.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $5,011.87 / $11,481.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,023.29 / $1,258.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $831.76 / $1,348.96
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $977.24 / $3,162.28
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
$660.69 / $676.08 / $870.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $707.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $3,630.78 / $7,585.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $776.25 / $1,318.26