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Wisconsin rates for HCPCS 21263

Periorbital osteotomies for orbital hypertelorism, with bone grafts; with forehead advancement

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $4,570.88 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,238.72 / $5,623.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $10,964.78 / $18,197.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $4,365.16 / $10,964.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,754.40 / $6,760.83 / $10,715.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,754.23 / $8,912.51 / $10,232.93
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $4,570.88 / $10,232.93
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,981.07 / $5,248.07 / $6,456.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $4,677.35 / $15,135.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $3,467.37 / $24,547.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,162.28 / $4,786.30 / $7,413.10
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,120.11 / $20,417.38 / $20,417.38
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,890.45 / $10,964.78 / $24,547.09
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,244.36 / $7,244.36 / $7,244.36
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,309.57 / $12,589.25 / $14,125.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,585.78 / $12,302.69 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $3,162.28 / $9,120.11