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Michigan 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
$676.08 / $4,897.79 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $676.08 / $1,122.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $831.76 / $831.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $776.25 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $758.58 / $1,230.27
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $2,344.23 / $6,918.31
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $794.33 / $1,122.02
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $741.31 / $1,096.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $4,786.30 / $8,709.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $758.58 / $1,047.13