go back

Wisconsin rates for HCPCS 21742

Repair Pectus Excavatm/Carinatm Minly W/O Thrsc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,157.63 / $1,157.63 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,103.16 / $1,186.06 / $1,881.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,169.00 / $8,408.00 / $12,444.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,150.28 / $2,671.45 / $7,175.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,586.21 / $3,022.20 / $4,636.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,500.53 / $4,017.39 / $4,565.21
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,051.38 / $1,503.65 / $2,378.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,127.74 / $1,881.89 / $13,120.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.86 / $1,813.44 / $9,587.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.00 / $85.00 / $2,686.50
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,127.74 / $1,503.65 / $2,378.09
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,266.73 / $2,876.54 / $4,124.50
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,517.70 / $15,517.70 / $15,517.70
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,197.16 / $5,724.60 / $9,587.96
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,223.99 / $3,223.99 / $3,223.99
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,903.99 / $6,499.52 / $6,499.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,301.00 / $11,608.00 / $13,980.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.86 / $1,904.41 / $4,152.78