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Virginia rates for HCPCS 21453

Closed treatment of mandibular fracture with interdental fixation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,079.93 / $4,390.00 / $8,003.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,153.00 / $7,363.00 / $9,410.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.00 / $640.00 / $1,490.09
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,035.33 / $1,339.83 / $1,583.44
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$877.39 / $1,154.40 / $1,764.20
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$689.07 / $1,067.14 / $3,715.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,423.00 / $11,475.00 / $21,639.00