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Texas 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
$895.00 / $3,620.00 / $12,480.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$696.12 / $1,164.94 / $5,935.52
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $644.91 / $665.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$767.20 / $767.20 / $767.20
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$75.27 / $75.27 / $75.27
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $8,354.39
Lucent Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$148.77 / $307.30 / $325.02
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$651.44 / $855.96 / $1,360.83
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$651.44 / $861.64 / $1,401.14
Providence
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$75.27 / $75.27 / $219.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,600.00 / $7,123.00 / $16,000.00