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Utah 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
$1,047.13 / $4,570.88 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $831.76 / $3,090.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $851.14 / $1,348.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,819.70
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,570.88 / $5,370.32 / $12,022.64
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,122.02 / $1,905.46
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $1,047.13 / $1,380.38
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $912.01 / $1,412.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $5,128.61 / $7,079.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $691.83 / $1,071.52