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Wisconsin rates for HCPCS 20802

Replantation Arm Complete Amputation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,619.38 / $5,502.40 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,525.03 / $2,720.59 / $12,482.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,499.00 / $16,401.00 / $37,855.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,621.71 / $5,950.65 / $15,448.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,920.60 / $8,087.27 / $12,406.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,626.68 / $10,669.05 / $12,123.93
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,445.51 / $3,461.55 / $5,788.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,539.59 / $5,387.90 / $17,940.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,780.22 / $5,329.44 / $20,642.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.55 / $1,631.49 / $5,184.51
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,445.51 / $3,461.55 / $5,788.83
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,380.05 / $6,555.38 / $9,785.90
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22,266.37 / $22,266.37 / $22,266.37
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,991.58 / $13,057.00 / $20,642.09
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,687.57 / $8,687.57 / $8,687.57
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,723.98 / $13,389.44 / $16,979.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,650.00 / $14,566.00 / $19,562.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,762.54 / $5,329.44 / $11,960.21