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Wisconsin rates for HCPCS 21423

Open treatment of palatal or maxillary fracture (LeFort I type); complicated (comminuted or involving cranial nerve foramina), multiple approaches

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,621.81 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $812.83 / $1,995.26
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
$758.58 / $1,621.81 / $3,890.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $2,398.83 / $3,801.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $3,235.94 / $3,630.78
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $1,621.81 / $7,244.36
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,905.46 / $2,454.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $1,698.24 / $13,182.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,380.38 / $6,606.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,737.80 / $2,630.27
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $7,244.36 / $7,244.36
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $3,715.35 / $6,760.83
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $2,570.40 / $2,570.40
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $4,466.84 / $5,011.87
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
$776.25 / $1,202.26 / $3,162.28