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Wisconsin rates for HCPCS 21141

Rcnstj Midface Lefort I 1 Piece W/O Bone Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,322.19 / $4,121.50 / $17,823.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,191.90 / $1,334.66 / $4,920.31
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,293.00 / $10,261.00 / $16,653.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,317.85 / $3,051.20 / $8,182.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,495.44 / $4,084.70 / $6,266.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,887.30 / $5,353.83 / $6,083.90
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,308.10 / $1,851.07 / $3,067.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,322.19 / $2,750.15 / $13,250.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,457.41 / $2,638.15 / $12,480.69
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.60 / $797.80 / $2,535.60
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,308.10 / $1,844.99 / $3,067.53
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,603.90 / $3,172.75 / $4,736.29
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,348.54 / $9,348.54 / $9,348.54
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,504.82 / $6,562.55 / $12,480.69
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,388.64 / $4,388.64 / $4,388.64
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,021.71 / $6,741.53 / $8,520.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,301.00 / $11,608.00 / $13,980.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,416.16 / $2,635.52 / $5,971.92