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Wisconsin rates for HCPCS 22612

Arthrodesis, posterior or posterolateral technique, single interspace; lumbar (with lateral transverse technique, when performed)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,484.75 / $9,580.00 / $26,690.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,878.00 / $15,141.00 / $22,609.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,509.27 / $1,895.23 / $14,551.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,920.77 / $4,581.72 / $7,028.50
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,484.75 / $2,173.78 / $3,545.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,491.69 / $3,147.67 / $15,090.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,484.75 / $2,173.78 / $3,545.71
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,121.95 / $3,803.98 / $5,678.59
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28,841.67 / $28,841.67 / $79,615.70
Quartz
Facility/Professional
Facility
Modifier
62
Low / Median / High Price
$47,165.25 / $47,165.25 / $47,165.25
Quartz
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$7,546.44 / $7,546.44 / $7,546.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,627.00 / $12,373.00 / $15,090.00