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Wisconsin rates for HCPCS 31622

Brnchsc Incl Fluor Gdnce Dx W/Cell Washg Spx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$156.13 / $474.66 / $5,717.36
Aetna
Facility/Professional
Facility
Modifier
52
Low / Median / High Price
$78.06 / $151.01 / $462.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.35 / $298.93 / $1,182.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.00 / $3,496.00 / $5,962.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.50 / $497.67 / $1,343.30
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.35 / $186.68 / $186.68
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.22 / $464.30 / $522.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$665.03 / $777.14 / $1,253.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.75 / $451.98 / $876.58
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.51 / $258.99 / $495.42
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$156.13 / $362.66 / $5,261.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.83 / $835.22 / $1,664.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $422.43 / $664.74
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.51 / $258.99 / $495.42
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$297.69 / $521.91 / $889.09
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,065.96 / $1,065.96 / $1,065.96
Quartz
Facility/Professional
Facility
Modifier
52
Low / Median / High Price
$472.30 / $472.30 / $472.30
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.89 / $1,059.53 / $1,853.04
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$598.04 / $776.23 / $1,505.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,976.00 / $4,155.00 / $5,865.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.26 / $731.55 / $1,048.30