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Wisconsin rates for HCPCS 21261

Periorbital Osteotomies W/Bone Grafts Icra & Xtr

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,351.09 / $4,911.21 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,251.44 / $2,417.48 / $11,297.10
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
$2,380.81 / $5,117.56 / $14,554.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,211.42 / $7,258.54 / $11,134.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,283.41 / $9,525.70 / $10,824.68
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,351.09 / $3,119.87 / $5,195.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,351.09 / $4,834.34 / $13,250.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,468.41 / $4,750.45 / $18,636.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.21 / $1,429.53 / $4,589.66
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,351.09 / $3,087.54 / $5,195.91
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,749.55 / $5,787.14 / $8,639.07
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33,817.44 / $33,817.44 / $33,817.44
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,456.66 / $11,817.05 / $18,636.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,806.60 / $7,806.60 / $7,806.60
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,899.65 / $12,101.15 / $15,159.60
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
$2,468.41 / $4,585.02 / $10,824.42