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Maryland rates for HCPCS 21421

Closed Tx Palatal/Maxillary Fx W/Fixation/Splint

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$538.89 / $632.65 / $778.15
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.97 / $604.00 / $740.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.00 / $641.21 / $1,316.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$550.49 / $840.31 / $1,661.55
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$675.16 / $870.96 / $1,163.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$520.00 / $520.00 / $733.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.47 / $817.86 / $1,541.20
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$675.16 / $776.43 / $961.83