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Wisconsin rates for HCPCS 21089

Unlisted maxillofacial prosthetic procedure

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $245.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $3,090.30 / $5,754.40
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $2,818.38 / $5,370.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $1,445.44 / $2,089.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,137.96 / $2,137.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,187.76 / $2,187.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,548.82 / $1,949.84