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Maine 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
$524.81 / $741.31 / $1,548.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $794.33 / $1,318.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $870.96 / $1,348.96
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $851.14 / $1,737.80
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $870.96 / $2,137.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $831.76 / $1,412.54