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Wisconsin rates for HCPCS 21180

Reconstruction, entire or majority of forehead and/or supraorbital rims; with autograft (includes obtaining grafts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $3,467.37 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,698.24 / $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 / $3,235.94 / $8,317.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,365.16 / $5,011.87 / $8,128.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $6,760.83 / $7,762.47
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $3,467.37 / $9,772.37
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $3,981.07 / $5,128.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $3,467.37 / $13,489.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,951.21 / $17,782.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $3,548.13 / $5,495.41
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $15,488.17 / $15,488.17
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $8,128.31 / $17,782.79
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,495.41 / $5,495.41 / $5,495.41
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,128.61 / $9,332.54 / $10,471.29
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 / $2,454.71 / $6,918.31