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Wisconsin rates for HCPCS 21047

Exc B9 Tum/Cst Mndbl Xtr-Oral Osteot&Prtl Mndb

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,198.16 / $2,510.64 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,141.32 / $1,203.73 / $5,230.51
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
$1,260.00 / $2,764.97 / $7,624.39
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
$3,149.41 / $3,680.34 / $5,645.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,869.12 / $4,849.43 / $5,510.73
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,198.16 / $1,785.04 / $2,647.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,198.16 / $2,461.86 / $13,250.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,408.07 / $2,573.66 / $9,976.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.64 / $709.56 / $2,262.26
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,198.16 / $1,764.00 / $2,647.93
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,379.65 / $2,899.51 / $4,328.39
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,994.41 / $5,994.41 / $16,547.20
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,268.84 / $6,226.80 / $9,976.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,046.38 / $6,395.24 / $7,717.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,301.00 / $11,608.00 / $13,980.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,385.40 / $2,560.12 / $5,666.39