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Wisconsin rates for HCPCS 20938

Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision) (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $346.74 / $14,454.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,754.40 / $6,165.95 / $6,165.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $512.86 / $812.83
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $354.81 / $10,000.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $389.05 / $11,220.18
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $389.05 / $575.44
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $1,288.25 / $1,288.25
Quartz
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$43.65 / $43.65 / $112.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,309.57 / $10,232.93 / $12,589.25