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Wisconsin rates for HCPCS 21088

Impression and custom preparation; facial prosthesis

Facilitymedian $5,012 · 10th–90th $3,090$12,0230%10%10th90th$5,012Professionalmedian $4,169 · 10th–90th $2,818$13,8040%10%10th90th$4,169$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,090.30 / $3,090.30 / $3,090.30
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,818.38 / $3,235.94 / $5,011.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,311.31 / $4,897.79 / $9,332.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,019.95 / $5,888.44 / $15,488.17
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,168.69 / $4,897.79 / $7,762.47
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,951.21 / $12,302.69 / $13,803.84
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,454.71 / $3,388.44 / $6,918.31
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,090.30 / $7,244.36 / $15,135.61
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,137.96 / $4,570.88 / $25,118.86
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8,317.64 / $9,332.54 / $15,848.93
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12,022.64 / $12,022.64 / $13,489.63
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7,079.46 / $12,589.25 / $18,197.01
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,884.03 / $14,125.38 / $21,379.62
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6,760.83 / $20,892.96 / $37,153.52
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,318.26 / $1,445.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,760.83 / $12,022.64 / $14,454.40
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $4,365.16 / $12,302.69