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Wisconsin rates for HCPCS 42120

Rescj Palate/Extensive Rescj Lesion

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,117.77 / $3,666.62 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,538.00 / $10,038.00 / $15,579.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,638.48 / $3,083.27 / $4,729.82
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$847.53 / $1,170.39 / $2,042.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$914.37 / $1,379.83 / $7,318.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$840.00 / $1,170.39 / $2,040.35
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,809.00 / $2,412.60 / $4,178.77
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,121.54 / $16,547.20 / $16,547.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,918.00 / $7,280.00 / $8,384.00