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Wisconsin rates for HCPCS 42500

Plstc Rpr Salivary Dux Sialodochoplasty Prim

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$386.36 / $929.79 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,479.00 / $8,746.00 / $15,579.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,205.70 / $1,408.95 / $2,161.37
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$351.05 / $506.14 / $851.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.59 / $523.95 / $5,080.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$351.05 / $506.14 / $851.97
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$731.70 / $1,068.82 / $1,538.74
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$582.25 / $2,454.78 / $16,547.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,918.00 / $7,280.00 / $8,384.00