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Wisconsin rates for HCPCS 40761

Plstc Rpr Cl Lip/Nsl Dfrm W/Cross Lip Pedcl Flap

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.00 / $2,192.21 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.67 / $1,174.00 / $3,708.37
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
$1,045.52 / $2,391.67 / $6,129.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,760.13 / $3,225.43 / $4,947.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,158.49 / $2,106.02 / $4,363.30
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,025.80 / $1,463.73 / $3,097.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,169.18 / $2,922.96 / $15,126.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,135.38 / $1,811.28 / $6,742.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.14 / $676.26 / $2,088.96
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,025.80 / $1,463.73 / $3,097.77
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,038.31 / $2,613.44 / $4,414.13
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
$1,478.00 / $4,463.72 / $9,006.77
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,865.14 / $3,865.14 / $3,865.14
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,441.56 / $5,327.60 / $5,327.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,217.00 / $11,608.00 / $13,980.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,099.58 / $1,654.64 / $5,072.08