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Wisconsin rates for HCPCS 49426

Revis Peritoneal-Venous Shunt

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$712.03 / $2,368.98 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$583.58 / $712.03 / $1,898.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,169.00 / $7,344.00 / $10,382.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$583.30 / $1,460.57 / $3,756.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,669.78 / $1,951.26 / $2,993.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$743.88 / $2,210.92 / $2,654.65
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$644.17 / $816.63 / $1,774.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$644.17 / $904.89 / $9,558.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$690.36 / $1,479.13 / $4,871.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.50 / $576.86 / $1,423.97
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$629.65 / $816.63 / $1,774.10
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,221.00 / $1,628.41 / $2,679.61
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$763.69 / $9,558.29 / $9,558.29
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,094.80 / $3,258.00 / $4,871.35
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,368.62 / $2,368.62 / $2,368.62
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,076.03 / $3,241.33 / $3,241.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,240.00 / $9,953.00 / $12,062.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$666.23 / $1,165.50 / $2,832.05