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Wisconsin rates for HCPCS 40804

Rmvl Embedded Fb Vestibule Mouth Smpl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.60 / $246.38 / $728.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.60 / $210.03 / $503.45
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,139.00 / $2,479.00 / $4,441.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.42 / $431.48 / $1,071.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$514.54 / $601.28 / $969.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.74 / $420.62 / $793.19
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.00 / $189.89 / $314.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.20 / $245.08 / $5,639.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.99 / $680.73 / $1,183.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $268.59 / $425.37
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.00 / $189.89 / $314.77
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.81 / $451.87 / $699.92
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$808.62 / $808.62 / $808.62
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.40 / $811.44 / $1,409.04
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.20 / $411.20 / $700.42
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$559.30 / $592.21 / $968.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,960.00 / $4,155.00 / $5,865.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.76 / $567.41 / $990.24