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Wisconsin rates for HCPCS 22102

Prtl Exc Pst Vrt Intrnsc B1y Les 1 Vrt Sgm Lmbr

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$750.97 / $1,553.96 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,878.00 / $14,586.00 / $21,869.00
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
$1,987.87 / $2,322.98 / $3,563.52
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$750.23 / $1,028.71 / $1,659.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$750.97 / $1,484.90 / $15,090.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$750.23 / $1,028.65 / $1,659.64
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,508.00 / $1,837.44 / $2,742.94
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
$8,627.00 / $12,373.00 / $15,090.00