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Wisconsin rates for HCPCS 21206

Osteotomy, maxilla, segmental (eg, Wassmund or Schuchard)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,023.29 / $2,691.53
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $2,089.30 / $5,754.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $3,981.07 / $4,570.88
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,344.23 / $3,019.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $2,089.30 / $10,964.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,089.30 / $3,162.28
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $5,623.41 / $10,964.78
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.30 / $6,165.95 / $6,309.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,737.80 / $4,786.30