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Rhode Island 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
$2,993.72 / $3,706.14 / $3,955.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$530.85 / $821.98 / $1,286.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.85 / $664.04 / $1,490.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$708.05 / $979.59 / $1,431.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,569.00 / $4,628.00 / $7,350.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.53 / $863.06 / $1,403.50