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Wisconsin rates for HCPCS 20500

Injection Sinus Tract Therapeutic Separate Proc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.50 / $260.69 / $1,894.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.50 / $122.33 / $460.45
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,183.00 / $3,483.00 / $5,962.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.05 / $240.06 / $627.10
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.79 / $166.79 / $166.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.51 / $388.57 / $596.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.66 / $329.51 / $544.48
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.98 / $139.03 / $259.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.50 / $173.79 / $4,292.39
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.82 / $301.76 / $1,443.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.91 / $116.31 / $255.89
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.50 / $139.03 / $259.87
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.66 / $292.32 / $416.04
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$156.18 / $156.18 / $421.12
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.30 / $528.89 / $1,443.28
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.69 / $574.16 / $799.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,723.00 / $3,912.00 / $5,865.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.79 / $232.52 / $507.10