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Wisconsin rates for HCPCS 21450

Closed Tx Mandibular Fracture W/O Manipulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$482.82 / $1,001.65 / $6,461.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$482.82 / $594.65 / $2,320.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,139.00 / $2,479.00 / $4,441.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$559.13 / $1,114.20 / $3,023.69
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.37 / $691.37 / $691.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,604.89 / $1,875.45 / $2,876.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$651.05 / $1,763.98 / $2,731.51
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$482.82 / $699.65 / $1,255.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.99 / $782.78 / $1,546.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591.24 / $1,265.94 / $4,385.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.59 / $348.33 / $1,139.96
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$482.82 / $699.65 / $1,255.33
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,062.59 / $1,402.63 / $2,011.15
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$561.03 / $561.03 / $3,396.96
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,019.96 / $2,530.35 / $4,385.92
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.84 / $1,621.84 / $2,000.96
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,492.69 / $3,110.19 / $3,825.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,034.00 / $1,423.00 / $2,202.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.30 / $1,088.01 / $2,560.01