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Wisconsin rates for HCPCS 21048

Excision of benign tumor or cyst of maxilla; requiring intra-oral osteotomy (eg, locally aggressive or destructive lesion[s])

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,096.48 / $3,715.35
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $2,041.74 / $5,888.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $4,073.80 / $4,677.35
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,398.83 / $3,090.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,995.26 / $9,120.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $2,187.76 / $3,311.31
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $5,248.07 / $9,120.11
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,162.28 / $5,754.40 / $6,456.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,621.81 / $4,466.84