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Arizona rates for HCPCS 21750

Closure of median sternotomy separation with or without debridement (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,965.00 / $4,474.00 / $7,960.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,763.75 / $6,640.00 / $10,860.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$638.95 / $868.01 / $8,546.89
Medica
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$166.38 / $166.38 / $307.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,255.00 / $7,205.00 / $11,396.00