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Wisconsin rates for HCPCS 21142

Rcnstj Midface Lefort I 2 Pieces W/O Bone Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,356.91 / $2,832.48 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,198.75 / $1,356.91 / $5,350.24
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
$1,354.25 / $3,131.33 / $8,400.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,585.56 / $4,190.01 / $6,427.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,912.24 / $5,492.67 / $6,241.68
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,342.40 / $1,899.67 / $3,147.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,342.40 / $2,828.30 / $13,442.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,476.44 / $2,803.24 / $13,111.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.60 / $797.80 / $2,611.62
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,342.40 / $1,895.95 / $3,147.20
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,672.15 / $3,255.91 / $4,860.43
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,790.00 / $12,790.00 / $12,790.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,569.78 / $6,743.25 / $13,111.43
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,505.59 / $4,505.59 / $4,505.59
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,121.18 / $6,921.97 / $8,741.27
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
$1,429.90 / $2,795.06 / $6,136.36