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Wisconsin rates for HCPCS 35903

Excision Infected Graft Extremity

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$670.88 / $1,079.85 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,060.00 / $7,344.00 / $10,517.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,361.59 / $1,591.13 / $2,566.42
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$527.92 / $836.81 / $1,680.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$605.65 / $6,241.00 / $12,216.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$527.92 / $836.81 / $1,680.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,079.00 / $1,666.14 / $2,200.75
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,984.00 / $7,984.00 / $7,984.00
Quartz
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$757.42 / $757.42 / $757.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,241.00 / $9,837.00 / $12,062.00