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Wisconsin rates for HCPCS 15572

Frmj Direct/Tube Pedicle W/Wo Tr Scalp Arms/Legs

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$611.92 / $1,505.66 / $6,461.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$611.92 / $767.31 / $1,809.32
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,060.00 / $7,344.00 / $10,517.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.27 / $1,816.67 / $3,817.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,314.98 / $2,705.23 / $4,149.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.04 / $1,304.89 / $2,393.46
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$715.96 / $1,101.93 / $2,412.42
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$727.12 / $1,528.80 / $10,568.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$829.87 / $1,683.96 / $5,440.32
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.88 / $491.24 / $1,528.26
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$715.96 / $1,101.93 / $2,412.42
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,551.80 / $2,114.64 / $2,937.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,411.97 / $1,887.09 / $5,169.18
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$846.67 / $3,544.30 / $6,525.60
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,557.98 / $3,070.78 / $3,749.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,241.00 / $9,837.00 / $12,062.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$820.45 / $1,332.26 / $3,514.59