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California rates for HCPCS 21431

Closed treatment of craniofacial separation (LeFort III type) using interdental wire fixation of denture or splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,992.00 / $7,648.00 / $18,309.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$618.41 / $725.98 / $3,737.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,222.00 / $8,869.27 / $20,146.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$703.56 / $1,025.73 / $2,034.90
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.40 / $100.00 / $5,714.18
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533.50 / $774.70 / $1,743.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,277.00 / $2,277.00 / $2,277.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.17 / $926.58 / $2,034.86
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.23 / $446.77 / $1,065.76
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$674.86 / $923.40 / $1,666.52
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $4,791.35 / $4,890.66
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,069.52 / $5,175.28 / $5,820.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$735.74 / $918.68 / $1,364.18
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.17 / $956.57 / $1,890.88
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,318.94 / $2,318.94 / $2,318.94
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.80 / $632.92 / $947.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,478.00 / $12,313.00 / $26,451.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.36 / $747.05 / $1,610.27