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Wyoming 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
Professional
Modifier
Low / Median / High Price
$537.03 / $660.69 / $977.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.23 / $2,754.23 / $2,754.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,584.89 / $1,862.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,174.90 / $1,949.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $2,754.23 / $10,471.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,148.15 / $2,570.40