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Wisconsin rates for HCPCS 21179

Rcnstj Forehead &/ Supraorb Rims W/Algrf/Prostc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,469.37 / $3,073.88 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,410.35 / $1,512.68 / $7,004.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,538.00 / $10,800.00 / $18,360.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,459.04 / $3,345.66 / $9,087.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,877.52 / $4,531.18 / $6,950.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,189.60 / $5,960.13 / $6,772.88
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,469.37 / $2,162.96 / $3,415.43
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,469.37 / $3,018.30 / $13,120.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,611.98 / $2,945.53 / $15,972.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.60 / $903.49 / $2,887.40
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,469.37 / $2,128.12 / $3,415.43
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,978.95 / $3,629.74 / $5,418.48
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,127.84 / $14,127.84 / $14,127.84
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,788.49 / $7,327.20 / $15,972.78
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,874.31 / $4,874.31 / $4,874.31
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,435.84 / $7,487.18 / $9,485.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,635.00 / $11,799.00 / $16,373.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,595.16 / $2,711.77 / $6,667.75