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Washington rates for HCPCS 21100

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

Facilitymedian $1,230 · 10th–90th $490$14,4540%10%10th90th$1,230Professionalmedian $708 · 10th–90th $363$1,5850%10%10th90th$708$20.0$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$691.83 / $2,290.87 / $17,782.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $630.96 / $1,412.54
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10,715.19 / $15,488.17 / $31,622.78
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$537.03 / $891.25 / $1,584.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $758.58 / $8,317.64
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$416.87 / $870.96 / $1,698.24
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $870.96 / $5,248.07
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$416.87 / $851.14 / $2,041.74
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $194.98
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$758.58 / $1,230.27 / $1,513.56
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$851.14 / $851.14 / $1,778.28
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $851.14 / $1,548.82
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10,715.19 / $16,218.10 / $31,622.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $851.14 / $1,513.56
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,467.37 / $17,378.01 / $33,884.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $812.83 / $1,513.56
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $707.95 / $912.01