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Washington rates for HCPCS 21421

Closed treatment of palatal or maxillary fracture (LeFort I type), with interdental wire fixation or fixation of denture or splint

Facilitymedian $1,445 · 10th–90th $832$13,8040%5%10%10th90th$1,445Professionalmedian $933 · 10th–90th $562$1,6980%5%10%10th90th$933$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $2,290.87 / $18,620.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $812.83 / $1,659.59
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,495.41 / $8,912.51 / $17,378.01
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,174.90 / $1,659.59
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$891.25 / $933.25 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $1,047.13 / $1,819.70
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$741.31 / $1,202.26 / $2,754.23
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $1,174.90 / $2,041.74
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $295.12
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$977.24 / $1,288.25 / $1,621.81
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $870.96 / $891.25
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $1,071.52 / $1,621.81
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,606.93 / $9,120.11 / $17,378.01
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $1,174.90 / $1,659.59
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,137.96 / $10,232.93 / $19,054.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $954.99 / $1,659.59
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $758.58 / $1,122.02