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Montana rates for HCPCS 21421

Closed treatment of palatal or maxillary fracture (LeFort I type), with interdental wire fixation or fixation of denture or splint

Facilitymedian $1,096 · 10th–90th $851–$1,3490%20%10th90th$1,096Professionalmedian $955 · 10th–90th $562–$1,6600%10%10th90th$955$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $891.25 / $1,862.09
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $851.14 / $1,023.29
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$851.14 / $851.14 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $776.25 / $1,174.90
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$933.25 / $1,096.48 / $1,348.96
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,096.48 / $1,348.96
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $912.01 / $1,380.38
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $870.96 / $1,318.26
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$831.76 / $831.76 / $6,760.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $1,047.13 / $1,380.38