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Pennsylvania rates for HCPCS 21453

Closed Tx Mandibular Fx W/Interdental Fixation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$990.80 / $2,747.00 / $8,104.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,639.91 / $11,851.00 / $26,582.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,490.09 / $1,490.09 / $1,490.09
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,101.13 / $20,824.13 / $34,151.42
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$990.81 / $3,838.00 / $8,427.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,490.09 / $1,490.09 / $1,490.09
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$728.33 / $900.80 / $1,056.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,332.00 / $3,879.00 / $7,508.00