go back

Wisconsin rates for HCPCS 21125

Augmentation, mandibular body or angle; prosthetic material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$661.32 / $2,639.68 / $13,367.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.32 / $2,597.21 / $5,649.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,479.00 / $9,096.00 / $15,579.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$890.64 / $1,983.22 / $4,586.63
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,995.29 / $5,995.29 / $5,995.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,062.08 / $8,252.60 / $12,659.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,098.52 / $3,064.31 / $11,956.24
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$624.73 / $1,461.52 / $5,359.67
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$653.04 / $2,535.36 / $7,318.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,887.42 / $6,356.99 / $19,122.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.57 / $1,467.29 / $4,760.50
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$643.10 / $1,461.52 / $5,359.67
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,553.62 / $3,007.86 / $8,564.16
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,707.47 / $4,707.47 / $7,597.71
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,590.91 / $9,616.04 / $19,122.08
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,195.67 / $2,195.67 / $9,023.12
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,094.71 / $4,291.52 / $16,744.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,614.00 / $7,611.00 / $9,134.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,835.06 / $5,630.85 / $12,602.09