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Wisconsin rates for HCPCS 21348

Open treatment of nasomaxillary complex fracture (LeFort II type); with bone grafting (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $2,238.72 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,096.48 / $3,311.31
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
$1,071.52 / $2,238.72 / $5,370.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $3,311.31 / $5,248.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $4,466.84 / $5,011.87
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $2,238.72 / $10,232.93
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,630.27 / $3,388.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $2,398.83 / $13,489.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $2,089.30 / $10,232.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $2,290.87 / $3,467.37
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $10,000.00 / $10,000.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $5,248.07 / $10,232.93
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $3,548.13
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,311.31 / $6,025.60 / $6,918.31
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
$1,148.15 / $1,698.24 / $4,466.84