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Wisconsin rates for HCPCS 21125

Augmentation, mandibular body or angle; prosthetic material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $2,630.27 / $13,489.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $2,344.23 / $4,365.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,165.95 / $10,232.93 / $17,378.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,905.46 / $4,168.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,079.46 / $8,317.64 / $13,182.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $3,090.30 / $12,302.69
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $2,630.27 / $6,456.54
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $2,630.27 / $7,079.46
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $2,754.23 / $8,128.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $6,025.60 / $19,054.61
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,023.29
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $3,019.95 / $8,511.38
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,585.78 / $14,125.38 / $20,892.96
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $13,803.84 / $18,197.01
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,187.76 / $9,120.11
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $4,265.80 / $16,595.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,897.79 / $7,413.10 / $9,120.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $2,818.38 / $9,772.37