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Wisconsin rates for HCPCS 40700

Plstc Rpr Cl Lip/Nsl Dfrm Prim Prtl/Compl Uni

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,099.03 / $2,056.48 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$937.04 / $1,099.03 / $3,722.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,538.00 / $9,948.00 / $15,579.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$971.93 / $2,203.17 / $5,731.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,595.23 / $3,032.73 / $4,652.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,048.07 / $1,979.58 / $4,093.53
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$955.42 / $1,360.70 / $2,892.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.79 / $2,741.97 / $15,126.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,024.33 / $1,766.23 / $6,263.21
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.84 / $769.65 / $1,990.47
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$955.42 / $1,360.70 / $2,892.72
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,909.12 / $2,447.81 / $4,141.21
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,221.88 / $16,547.20 / $16,547.20
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,386.61 / $4,187.75 / $9,966.91
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,613.83 / $3,613.83 / $3,613.83
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,566.94 / $4,998.18 / $4,998.18
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
$989.48 / $1,571.46 / $4,380.92