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Wisconsin rates for HCPCS 21210

Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$750.48 / $1,770.97 / $13,367.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.48 / $1,770.97 / $4,147.18
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,538.00 / $9,948.00 / $15,579.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$956.65 / $2,054.48 / $4,936.50
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,995.29 / $5,995.29 / $5,995.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,759.72 / $5,562.10 / $8,532.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,243.07 / $3,349.35 / $7,840.09
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$750.48 / $1,658.56 / $3,754.46
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$767.19 / $1,851.27 / $12,202.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,965.30 / $4,439.97 / $13,032.48
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $1,023.18 / $3,276.74
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$750.48 / $1,658.56 / $3,754.46
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,767.18 / $3,339.30 / $5,889.68
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,349.66 / $5,349.66 / $8,177.99
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,808.20 / $7,351.00 / $13,032.48
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,830.73 / $4,877.64 / $11,357.59
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
$1,963.70 / $4,271.08 / $8,830.62