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Wisconsin rates for HCPCS 21089

Unlisted maxillofacial prosthetic procedure

Facilitymedian $2,884 · 10th–90th $1,380–$5,7540%10%20%10th90th$2,884Professionalmedian $33 · 10th–90th $32–$2,1380%50%10th90th$33$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

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

Insurance Carrier
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,584.89 / $3,090.30 / $5,754.40
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,238.72 / $2,818.38 / $5,370.32
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$616.60 / $1,445.44 / $2,089.30
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,137.96 / $2,137.96 / $2,137.96
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
$831.76 / $933.25 / $2,344.23
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,187.76 / $2,187.76 / $2,187.76
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$977.24 / $1,584.89 / $2,187.76