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Wisconsin rates for HCPCS 40720

Plstc Rpr Cl Lip/Nsl Dfrm Sec Recrtj Dfct & Recl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,118.19 / $2,090.09 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$952.77 / $1,118.19 / $3,784.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,740.00 / $4,780.00 / $10,038.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$992.31 / $2,293.71 / $5,832.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,633.97 / $3,078.01 / $4,721.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,131.68 / $2,009.49 / $4,160.20
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$974.85 / $1,389.23 / $2,944.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,114.72 / $2,786.79 / $13,250.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,076.55 / $1,748.91 / $6,395.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.84 / $791.26 / $2,019.62
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$974.85 / $1,389.23 / $2,944.59
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,940.95 / $2,488.62 / $4,208.68
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,363.88 / $8,374.87 / $8,374.87
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,409.19 / $4,255.97 / $7,552.64
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,677.59 / $3,677.59 / $3,677.59
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,526.50 / $5,079.60 / $5,079.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,266.00 / $11,608.00 / $13,980.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,006.56 / $1,609.66 / $5,129.57