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Wisconsin rates for HCPCS 21080

Impression & Prepj Definitive Obturator Prosthes

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,309.16 / $1,649.66 / $6,253.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,309.16 / $1,649.66 / $6,628.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,740.00 / $4,780.00 / $10,038.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,699.57 / $3,021.15 / $8,632.70
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,333.06 / $2,333.06 / $2,333.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,373.14 / $5,110.35 / $7,839.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,100.17 / $4,627.99 / $7,615.69
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,309.16 / $2,100.94 / $3,508.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,382.98 / $2,474.48 / $11,733.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,013.25 / $3,911.00 / $12,434.32
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.11 / $993.30 / $3,212.90
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,309.16 / $2,020.63 / $3,508.94
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,952.33 / $4,010.00 / $5,772.25
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,552.59 / $1,552.59 / $6,070.38
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,833.27 / $7,054.83 / $12,434.32
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,229.10 / $8,422.44 / $10,665.51
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
$1,893.92 / $3,690.80 / $7,753.15