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Wisconsin rates for HCPCS 21141

Reconstruction midface, LeFort I; single piece, segment movement in any direction (eg, for Long Face Syndrome), without bone graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $4,168.69 / $23,442.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,445.44 / $3,801.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $10,964.78 / $18,197.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $2,754.23 / $6,760.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $4,073.80 / $6,456.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $5,495.41 / $6,165.95
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $2,754.23 / $6,918.31
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $3,235.94 / $4,168.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $2,951.21 / $15,135.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,398.83 / $12,589.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,122.02
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,884.03 / $4,365.16
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $9,120.11 / $9,120.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $6,606.93 / $12,589.25
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,365.16 / $4,365.16 / $4,365.16
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,801.89 / $7,585.78 / $8,511.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,585.78 / $12,302.69 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $2,041.74 / $5,623.41