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Indiana 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
$831.76 / $4,897.79 / $14,125.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $645.65 / $1,148.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,801.89 / $8,317.64 / $10,964.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $562.34 / $933.25
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $549.54 / $630.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $851.14 / $1,698.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $707.95 / $1,202.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $6,025.60 / $10,715.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $676.08 / $1,202.26