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Wisconsin rates for HCPCS 21453

Closed treatment of mandibular fracture with interdental fixation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $1,905.46 / $6,456.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $10,964.78 / $18,197.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $3,467.37 / $5,754.40
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $1,479.11 / $4,677.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $1,548.82 / $13,182.57
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $2,630.27 / $3,715.35
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $11,220.18 / $16,595.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,585.78 / $12,302.69 / $16,218.10