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Massachusetts 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
$812.83 / $3,388.44 / $5,370.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $724.44 / $1,698.24
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $4,897.79 / $33,884.42
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $912.01 / $2,238.72
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $660.69 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $977.24 / $1,778.28
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $1,148.15 / $7,079.46
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $954.99 / $1,348.96
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $4,265.80 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $1,047.13 / $1,737.80
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $4,897.79 / $33,884.42
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $912.01 / $2,238.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.09 / $4,265.80 / $9,772.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $954.99 / $1,819.70