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Wisconsin rates for HCPCS 21138

Rdctj Fhd Cntrg & Prosthetic Matrl/Bone Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$887.71 / $1,866.24 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$850.10 / $918.64 / $4,217.49
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,538.00 / $9,948.00 / $15,579.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$882.67 / $2,048.56 / $5,735.37
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,995.29 / $5,995.29 / $5,995.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,355.53 / $2,752.62 / $4,222.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,332.62 / $3,611.20 / $4,103.64
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$887.71 / $1,253.60 / $2,073.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$887.71 / $1,838.41 / $13,250.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$972.79 / $1,780.28 / $8,385.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.47 / $549.66 / $1,756.75
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$887.71 / $1,244.16 / $2,073.60
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,804.40 / $2,198.59 / $3,282.06
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,994.41 / $5,994.41 / $16,547.20
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,689.52 / $4,411.60 / $8,385.95
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,934.25 / $2,934.25 / $2,934.25
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,984.89 / $4,507.18 / $5,746.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,301.00 / $11,608.00 / $13,980.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$962.35 / $1,764.64 / $4,041.03