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Wisconsin rates for HCPCS 42505

Plastic repair of salivary duct, sialodochoplasty; secondary or complicated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $1,174.90 / $8,317.64
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $10,964.78 / $18,197.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $1,778.28 / $2,884.03
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $645.65 / $4,466.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $676.08 / $8,511.38
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,174.90 / $1,995.26
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,220.18 / $16,595.87 / $16,595.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,585.78 / $12,302.69 / $16,218.10