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Missouri 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 / $4,168.69 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $676.08 / $1,905.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $4,677.35 / $8,912.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $691.83 / $1,047.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $691.83 / $954.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $831.76 / $1,348.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $912.01 / $3,981.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,000.00 / $4,786.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $2,630.27 / $4,677.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $741.31 / $1,174.90