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Wisconsin rates for HCPCS 21256

Reconstruction Orbit W/Osteotomies & Bone Grafts

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,200.97 / $2,526.26 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,150.67 / $1,243.33 / $5,710.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,293.00 / $10,261.00 / $16,653.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,195.79 / $2,771.46 / $7,060.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,186.36 / $3,723.51 / $5,711.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,716.40 / $4,888.08 / $5,554.64
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,200.97 / $1,681.36 / $2,806.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,200.97 / $2,493.25 / $13,250.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,298.50 / $2,401.23 / $14,641.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.60 / $745.32 / $2,395.26
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,200.97 / $1,674.11 / $2,806.95
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,443.35 / $2,977.13 / $4,444.27
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,960.05 / $13,960.05 / $13,960.05
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,286.92 / $7,466.25 / $14,641.99
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,970.35 / $3,970.35 / $3,970.35
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,982.13 / $7,779.12 / $7,779.12
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
$1,298.50 / $2,375.08 / $5,538.00