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Wisconsin rates for HCPCS 21421

Closed Tx Palatal/Maxillary Fx W/Fixation/Splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$544.12 / $1,146.06 / $8,243.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$544.12 / $659.69 / $2,810.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,740.00 / $4,780.00 / $7,344.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$688.08 / $1,255.67 / $3,598.69
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,669.32 / $2,669.32 / $2,669.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.36 / $2,030.24 / $3,114.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$822.41 / $1,960.89 / $2,980.09
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$544.12 / $815.30 / $1,366.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$563.80 / $963.31 / $7,160.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$761.34 / $1,649.24 / $4,812.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.47 / $383.62 / $1,253.47
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$544.12 / $814.98 / $1,366.49
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,208.45 / $1,549.15 / $2,303.28
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,865.24 / $2,865.24 / $3,850.56
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,187.15 / $2,766.75 / $4,812.16
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,812.86 / $1,812.86 / $2,152.83
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,934.28 / $3,521.21 / $4,173.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,918.00 / $6,754.00 / $8,384.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$728.46 / $1,440.31 / $3,004.89