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Wisconsin rates for HCPCS 15576

Frmj Direct/Tubed Pedicle W/Wotr E/N/E/L/Ntroral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$545.62 / $1,344.15 / $6,461.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$545.62 / $681.54 / $1,304.49
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
$775.90 / $1,634.69 / $3,424.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,073.48 / $2,423.02 / $3,716.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.44 / $1,164.94 / $2,146.88
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$638.61 / $979.36 / $2,159.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$662.52 / $1,359.37 / $4,821.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$779.28 / $1,556.19 / $5,828.24
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.88 / $449.55 / $1,433.62
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$638.61 / $979.36 / $2,159.85
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,374.54 / $1,868.78 / $2,601.50
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,260.51 / $1,684.67 / $4,557.24
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$754.04 / $3,197.80 / $5,828.24
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,421.62 / $2,768.33 / $3,358.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,976.00 / $4,155.00 / $5,865.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.98 / $1,254.09 / $3,078.81