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Wisconsin rates for HCPCS 21435

Open treatment of craniofacial separation (LeFort III type); complicated, utilizing internal and/or external fixation techniques (eg, head cap, halo device, and/or intermaxillary fixation)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $2,884.03 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,412.54 / $3,548.13
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
$1,380.38 / $2,818.38 / $6,918.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $4,265.80 / $6,760.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $5,623.41 / $6,456.54
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $2,818.38 / $7,244.36
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $3,311.31 / $4,265.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $2,884.03 / $13,489.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $2,290.87 / $10,964.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $3,019.95 / $4,570.88
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $12,882.50 / $12,882.50
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $6,760.83 / $10,964.78
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $4,466.84
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,388.44 / $7,762.47 / $8,912.51
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
$1,318.26 / $2,041.74 / $5,754.40