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Louisiana 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
$794.33 / $2,570.40 / $5,370.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $724.44 / $1,096.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $5,011.87 / $6,918.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $812.83 / $1,000.00
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $501.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $831.76 / $1,230.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $2,630.27 / $6,606.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $707.95 / $1,122.02