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Maryland 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
Professional
Modifier
Low / Median / High Price
$512.86 / $676.08 / $1,778.28
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $602.56 / $758.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $645.65 / $1,318.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $812.83 / $1,513.56
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $794.33 / $1,258.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $537.03 / $741.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $724.44 / $1,318.26
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $812.83 / $1,047.13