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Wisconsin rates for HCPCS 21275

Secondary Revision Orbitocraniofacial Rcnstj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$820.04 / $1,719.56 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$784.87 / $846.21 / $3,875.19
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
$808.21 / $1,892.40 / $5,294.36
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
$2,175.30 / $2,542.01 / $3,899.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,226.58 / $3,333.51 / $3,788.08
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$820.04 / $1,131.49 / $1,910.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$820.04 / $1,693.66 / $13,250.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$892.46 / $1,629.53 / $14,641.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.66 / $489.21 / $1,598.95
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$820.04 / $1,131.49 / $1,910.63
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,661.40 / $2,024.35 / $3,021.96
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,617.86 / $7,617.86 / $21,028.65
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,559.61 / $4,053.55 / $14,641.99
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,715.99 / $2,715.99 / $2,715.99
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,762.16 / $4,162.35 / $5,305.13
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
$845.93 / $1,622.66 / $3,688.73