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Wisconsin rates for HCPCS 21146

Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted unilateral alveolar cleft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $3,311.31 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,621.81 / $4,570.88
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
$1,621.81 / $3,311.31 / $8,128.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $4,897.79 / $7,943.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $6,606.93 / $7,585.78
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $3,311.31 / $9,772.37
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.03 / $3,890.45 / $5,011.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $3,548.13 / $13,489.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $3,388.44 / $14,454.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $3,467.37 / $5,248.07
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,168.69 / $14,791.08 / $14,791.08
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.03 / $7,943.28 / $14,454.40
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,370.32 / $5,370.32 / $5,370.32
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,011.87 / $9,120.11 / $10,232.93
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
$1,659.59 / $2,818.38 / $6,760.83