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Idaho 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
$1,628.00 / $4,500.00 / $7,205.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$463.17 / $730.89 / $1,282.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,502.28 / $3,502.28 / $3,512.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$449.58 / $715.06 / $1,196.34
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$360.66 / $767.43 / $1,475.11
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$586.55 / $998.58 / $1,270.61
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $862.82 / $1,085.49
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,660.78 / $14,097.25 / $17,807.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$607.32 / $858.86 / $1,384.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,100.00 / $10,120.00 / $27,159.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$721.49 / $1,022.77 / $1,481.80