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Wisconsin rates for HCPCS 55874

Transperineal Plmt Biodegradable Matrl 1/Mlt Njx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$337.79 / $5,692.50 / $10,831.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.28 / $3,221.21 / $7,654.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,538.00 / $9,720.00 / $15,579.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.32 / $3,398.60 / $15,011.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,844.25 / $9,166.62 / $14,785.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.37 / $817.07 / $10,305.95
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.28 / $337.51 / $4,759.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.16 / $4,759.29 / $15,090.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,578.66 / $10,269.87 / $17,097.68
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $2,678.77 / $6,443.35
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.28 / $337.51 / $4,759.29
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.78 / $2,645.91 / $9,670.03
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,144.02 / $1,144.02 / $1,144.02
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.68 / $5,424.90 / $20,949.68
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$790.99 / $9,678.39 / $14,041.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,627.00 / $12,373.00 / $15,090.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,545.95 / $10,321.20 / $14,773.86