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Pennsylvania 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
$1,023.29 / $5,370.32 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $676.08 / $1,412.54
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $7,585.78 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $870.96 / $1,096.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $912.01 / $912.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $758.58 / $1,258.93
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,071.52 / $1,348.96
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $812.83 / $1,380.38
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,791.08 / $14,791.08 / $14,791.08
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $4,570.88 / $8,511.38
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $851.14 / $1,905.46
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $602.56 / $1,348.96
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $602.56 / $1,659.59
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $537.03 / $616.60
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $575.44 / $630.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $3,548.13 / $10,232.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $707.95 / $1,202.26