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Wisconsin rates for HCPCS 21180

Rcnstj Forehead &/ Supraorbital Rims W/Autograft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,640.10 / $3,431.27 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,574.97 / $1,688.24 / $7,832.17
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
$1,635.84 / $3,280.20 / $10,146.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,323.57 / $5,052.43 / $7,750.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,442.30 / $6,650.77 / $7,557.69
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,640.10 / $2,339.83 / $3,812.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,640.10 / $3,367.65 / $13,120.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,784.27 / $3,293.45 / $17,970.61
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.95 / $1,000.26 / $3,243.68
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,640.10 / $2,339.83 / $3,812.53
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,326.05 / $4,052.66 / $6,049.83
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,766.96 / $15,766.96 / $15,766.96
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,111.61 / $8,192.65 / $17,970.61
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,442.10 / $5,442.10 / $5,442.10
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,078.32 / $8,362.15 / $10,584.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,266.00 / $11,608.00 / $13,980.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,784.27 / $3,178.75 / $7,455.31