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Wisconsin rates for HCPCS 42650

Dilation salivary duct

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $154.88 / $17,782.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $75.86 / $147.91
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $4,570.88 / $7,079.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $134.90 / $354.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $229.09 / $371.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $125.89 / $288.40
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.48 / $77.62 / $2,238.72
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $147.91 / $218.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $79.43 / $3,235.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $186.21 / $549.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $154.88 / $257.04
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $1,380.38 / $1,380.38
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $186.21 / $537.03
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $295.12 / $380.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $3,801.89 / $6,456.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $95.50 / $257.04