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Virginia rates for HCPCS 21450

Closed treatment of mandibular fracture; without manipulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$641.35 / $4,390.00 / $8,294.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$479.91 / $554.95 / $677.55
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,735.00 / $2,390.00 / $2,954.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$437.61 / $566.71 / $936.94
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.71 / $549.71 / $1,071.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.00 / $640.00 / $782.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$454.54 / $673.85 / $1,177.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$566.41 / $733.00 / $866.27
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$517.69 / $679.83 / $1,050.59
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$694.00 / $814.00 / $1,132.32
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$399.33 / $600.86 / $1,121.49
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$485.11 / $742.50 / $1,366.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$231.00 / $1,045.00 / $2,364.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.00 / $669.62 / $1,125.38