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Wisconsin rates for HCPCS 40702

Plastic repair of cleft lip/nasal deformity; primary bilateral, 1 of 2 stages

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $2,041.74 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,047.13 / $2,041.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $10,964.78 / $18,197.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,905.46 / $5,623.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $3,019.95 / $4,786.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $2,187.76 / $4,168.69
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $2,884.03 / $5,754.40
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,454.71 / $3,090.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $2,951.21 / $15,135.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,513.56 / $6,025.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,096.48
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $2,137.96 / $3,311.31
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,220.18 / $16,595.87 / $16,595.87
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,819.70 / $7,585.78
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $3,548.13
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,235.94 / $4,897.79 / $5,495.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,585.78 / $12,302.69 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,479.11 / $4,265.80