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Wisconsin rates for HCPCS 21263

Periorbital Osteotomies W/Bone Grafts W/Forehead

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,176.44 / $4,546.13 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,082.85 / $2,237.46 / $10,449.50
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
$2,202.29 / $4,663.41 / $13,474.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,755.45 / $6,725.70 / $10,317.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,882.84 / $8,819.68 / $10,022.36
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,176.44 / $2,886.16 / $5,051.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,176.44 / $4,478.06 / $13,250.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,220.40 / $4,394.02 / $24,626.21
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.38 / $1,327.76 / $4,217.27
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,176.44 / $2,852.20 / $5,051.25
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,392.70 / $5,352.34 / $7,989.98
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,864.72 / $20,864.72 / $20,864.72
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,126.34 / $10,930.40 / $24,626.21
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,227.14 / $7,227.14 / $7,227.14
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,373.69 / $11,202.40 / $14,036.02
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
$2,220.40 / $4,468.52 / $9,618.75