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Wisconsin rates for HCPCS D7111

Extraction Coronal Remnants-Primary Tooth

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.57 / $46.57 / $46.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.57 / $50.77 / $56.47
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.99 / $107.55 / $224.41
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.02 / $56.47 / $116.47
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.63 / $30.63 / $30.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.02 / $56.47 / $116.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.79 / $352.42 / $352.42
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $149.74
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.02 / $56.47 / $116.47
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.63 / $30.63 / $30.63
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.65 / $144.35 / $207.81
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,062.89 / $5,062.89 / $5,062.89
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.86 / $352.42 / $352.42
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.70 / $76.98 / $83.82