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New Hampshire 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
$2,187.76 / $2,570.40 / $14,791.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $741.31 / $1,288.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,737.80 / $3,019.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $891.25 / $1,230.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $2,570.40 / $2,570.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,071.52 / $1,949.84
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $9,549.93 / $9,549.93
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,000.00 / $1,584.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $9,549.93 / $9,549.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $954.99 / $1,737.80
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $501.19 / $794.33