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Wisconsin rates for HCPCS 20926

Tissue Grafts, Other (Eg, Paratenon, Fat, Dermis)

Insurance Carrier
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,925.80 / $3,925.80 / $3,925.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,038.08 / $1,213.08 / $1,860.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$783.13 / $2,845.30 / $3,233.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,625.27 / $2,625.27 / $2,625.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $55.00 / $70.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,138.20 / $8,138.20 / $8,138.20
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,455.97 / $2,625.27 / $2,625.27