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Wisconsin rates for HCPCS 42200

Palatoplasty for cleft palate, soft and/or hard palate only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,905.46 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,023.29 / $2,570.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $10,964.78 / $18,197.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,737.80 / $4,466.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $2,818.38 / $4,466.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,949.84 / $3,801.89
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $1,174.90 / $6,025.60
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,995.26 / $2,884.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $1,258.93 / $13,182.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,584.89 / $9,772.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,995.26 / $3,090.30
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,220.18 / $16,595.87 / $16,595.87
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $4,570.88 / $9,772.37
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,311.31 / $3,311.31 / $3,311.31
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $3,311.31 / $4,570.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,585.78 / $12,302.69 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,230.27 / $3,548.13