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Wisconsin rates for HCPCS 42104

Exc Lesion Palate Uvula W/O Closure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.97 / $448.00 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.25 / $201.23 / $511.68
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.00 / $3,193.00 / $5,962.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.59 / $418.61 / $1,143.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.53 / $686.58 / $1,053.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.97 / $444.70 / $908.79
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.19 / $221.06 / $409.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.26 / $227.23 / $2,781.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.91 / $728.26 / $1,619.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.82 / $324.69 / $501.39
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.19 / $221.06 / $409.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.01 / $484.74 / $738.14
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$226.85 / $956.88 / $2,000.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.30 / $929.70 / $1,619.04
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$497.89 / $685.34 / $1,109.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,976.00 / $3,912.00 / $6,072.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.53 / $425.31 / $949.79