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Wisconsin rates for HCPCS 21451

Closed treatment of mandibular fracture; with manipulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$644.03 / $1,335.94 / $8,243.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$644.03 / $772.26 / $3,024.68
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,183.00 / $3,483.00 / $5,962.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$737.80 / $1,486.22 / $4,033.41
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,554.79 / $1,554.79 / $1,554.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,080.69 / $2,431.44 / $3,729.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$873.71 / $2,292.17 / $3,551.60
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$644.03 / $901.64 / $1,608.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$650.97 / $1,067.54 / $4,292.39
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$777.73 / $1,680.48 / $5,713.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.96 / $452.03 / $1,478.61
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$644.03 / $890.63 / $1,608.89
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,406.09 / $1,828.73 / $2,622.10
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,350.75 / $1,350.75 / $4,527.47
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,358.92 / $3,290.04 / $5,713.92
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,163.42 / $2,163.42 / $2,595.10
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,990.84 / $4,143.85 / $4,973.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,960.00 / $4,155.00 / $5,865.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$747.25 / $1,534.56 / $3,356.08