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Wisconsin rates for HCPCS 21260

Periorbital osteotomies for orbital hypertelorism, with bone grafts; extracranial approach

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,332.07 / $2,780.80 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,272.13 / $1,368.95 / $6,383.74
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
$1,347.04 / $3,005.46 / $8,250.90
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
$3,528.79 / $4,123.67 / $6,325.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,972.75 / $5,396.67 / $6,132.58
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,332.07 / $1,762.84 / $3,089.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,332.07 / $2,745.16 / $13,250.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.88 / $2,684.38 / $14,907.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.60 / $802.63 / $2,589.57
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,332.07 / $1,736.35 / $3,089.78
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,681.90 / $3,267.79 / $4,878.17
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,994.41 / $5,994.41 / $16,547.20
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,524.86 / $6,677.55 / $14,907.82
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,425.55 / $4,425.55 / $4,425.55
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,080.52 / $6,870.62 / $8,588.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,301.00 / $11,608.00 / $13,980.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,447.19 / $2,671.02 / $6,076.57