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Wisconsin rates for HCPCS 20902

Bone Graft Any Donor Area Major/Large

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$264.01 / $980.57 / $17,823.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,139.00 / $13,743.77 / $21,606.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,560.77 / $7,560.77 / $7,560.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$693.86 / $810.83 / $1,243.83
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$264.01 / $396.02 / $884.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$268.54 / $583.46 / $11,598.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$264.01 / $396.02 / $884.66
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$534.95 / $651.82 / $973.03
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,213.88 / $7,213.88 / $19,913.50
Quartz
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$1,887.52 / $1,887.52 / $1,887.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,241.00 / $9,837.00 / $12,062.00