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Arizona rates for HCPCS 21100

Application of halo type appliance for maxillofacial fixation, includes removal (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,582.00 / $2,912.00 / $6,483.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.12 / $562.41 / $1,986.47
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.35 / $2,211.19 / $3,616.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.43 / $558.04 / $831.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.10 / $627.16 / $1,167.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.68 / $618.66 / $6,455.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$597.38 / $878.00 / $4,610.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,637.00 / $6,477.00 / $9,010.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$587.14 / $719.72 / $1,346.57