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Oklahoma 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
$1,000.00 / $2,630.27 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $676.08 / $1,174.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,912.51 / $13,803.84 / $22,387.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $676.08 / $851.14
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
$575.44 / $812.83 / $1,122.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $891.25 / $5,495.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $812.83 / $4,786.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $3,235.94 / $6,025.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $645.65 / $891.25