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South Carolina 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
$724.44 / $9,120.11 / $18,197.01
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
$2,290.87 / $5,495.41 / $10,232.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $645.65 / $933.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $912.01 / $2,290.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $851.14 / $1,380.38
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $912.01 / $1,548.82
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $831.76 / $1,412.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $11,220.18 / $16,982.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $691.83 / $1,122.02