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Nebraska 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
$1,348.96 / $7,585.78 / $13,489.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $676.08 / $3,090.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $8,511.38 / $16,595.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $912.01 / $1,258.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $2,238.72 / $2,238.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,318.26 / $1,949.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $977.24 / $4,073.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,348.96 / $4,786.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,513.56 / $1,995.26
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $2,238.72 / $2,238.72
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,479.11 / $1,995.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $5,011.87 / $8,128.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $1,071.52 / $1,621.81