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Wisconsin 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
$549.54 / $1,148.15 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $660.69 / $1,737.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $4,786.30 / $7,585.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,122.02 / $3,090.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $2,041.74 / $3,235.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,949.84 / $3,019.95
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $954.99 / $5,623.41
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,380.38 / $2,041.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $1,047.13 / $7,762.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,479.11 / $4,786.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $870.96
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,548.82 / $2,290.87
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $5,370.32 / $7,943.28
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $3,311.31 / $4,677.35
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $2,137.96
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $3,548.13 / $4,168.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,897.79 / $7,413.10 / $9,120.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $1,023.29 / $2,630.27