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Washington rates for HCPCS 21421

Closed Tx Palatal/Maxillary Fx W/Fixation/Splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$896.66 / $2,223.10 / $18,711.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$607.69 / $896.66 / $2,274.15
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,623.53 / $9,124.02 / $20,178.18
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$884.75 / $1,370.34 / $4,812.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$883.20 / $1,075.31 / $3,302.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.16 / $1,201.29 / $1,892.35
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$722.30 / $1,351.40 / $2,494.19
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$722.30 / $1,328.65 / $2,089.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.68 / $371.42 / $1,284.53
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$983.70 / $1,284.26 / $1,591.20
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$803.50 / $872.03 / $2,412.73
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$884.75 / $1,284.74 / $1,621.79
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,812.14 / $9,118.81 / $17,453.22
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$790.52 / $1,182.68 / $1,602.73
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,408.00 / $11,261.00 / $18,553.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$785.97 / $1,092.69 / $1,897.83
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$539.99 / $612.42 / $730.42