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Washington rates for HCPCS 21433

Open treatment of craniofacial separation (LeFort III type); complicated (eg, comminuted or involving cranial nerve foramina), multiple surgical approaches

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,197.86 / $5,128.00 / $21,917.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,607.77 / $2,197.86 / $4,950.46
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,370.00 / $15,127.44 / $28,937.08
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,477.35 / $4,038.14 / $15,026.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$765.00 / $870.49 / $870.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,844.31 / $3,104.46 / $5,224.35
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,658.00 / $3,412.14 / $4,791.06
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,656.33 / $3,359.81 / $4,402.39
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.74 / $987.98 / $3,378.32
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,428.80 / $3,358.71 / $3,474.62
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,324.34 / $2,324.34 / $2,370.00
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,660.46 / $3,796.94 / $4,704.22
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,555.00 / $15,127.44 / $28,937.08
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,370.52 / $3,373.39 / $4,491.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $4,016.00 / $16,315.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,121.42 / $2,778.05 / $4,999.35
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,444.66 / $1,444.66 / $1,857.35