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Wisconsin rates for HCPCS 57400

Dilation Vagina W/Anesthesia Other Than Local

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.16 / $262.37 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.02 / $138.16 / $449.79
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,740.00 / $4,780.00 / $7,344.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.89 / $351.89 / $709.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$330.71 / $386.46 / $623.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.40 / $378.68 / $526.85
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.27 / $156.10 / $250.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.16 / $4,103.00 / $8,384.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.47 / $316.88 / $626.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.78 / $168.07 / $239.36
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.27 / $156.10 / $250.71
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.80 / $393.45 / $463.46
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,496.40 / $9,496.40 / $9,496.40
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.47 / $633.75 / $1,068.90
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.92 / $318.92 / $318.92
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.48 / $691.78 / $691.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,918.00 / $6,477.00 / $8,384.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.54 / $370.31 / $555.48