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Wisconsin rates for HCPCS 42215

Palatoplasty Cleft Palate Major Revj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$771.22 / $2,560.98 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$652.42 / $771.22 / $2,031.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,538.00 / $10,038.00 / $15,579.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$693.48 / $1,581.98 / $4,040.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,824.77 / $2,132.39 / $3,271.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$813.22 / $2,323.55 / $2,868.11
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$684.51 / $920.18 / $1,701.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$663.79 / $1,009.72 / $12,855.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.61 / $1,628.58 / $11,064.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.50 / $615.48 / $1,534.65
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$663.79 / $903.23 / $1,701.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,278.00 / $1,704.43 / $2,901.53
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$792.33 / $16,547.20 / $16,547.20
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$971.53 / $3,440.75 / $11,064.05
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,539.08 / $2,539.08 / $2,539.08
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,321.48 / $3,501.99 / $3,501.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,301.00 / $11,799.00 / $13,980.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.61 / $1,628.58 / $3,105.28