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Virginia 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
$768.65 / $5,412.00 / $11,024.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,142.00 / $20,977.18 / $29,216.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.00 / $640.00 / $767.20
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$75.27 / $75.27 / $75.27
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$632.91 / $810.12 / $950.11
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$690.28 / $903.74 / $1,292.27
Medcost
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$125.36 / $149.10 / $247.60
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$663.13 / $890.20 / $3,196.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,408.00 / $13,296.00 / $26,537.00