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Wisconsin rates for HCPCS 57220

Plastic Urethral Sphincter Vaginal Approach

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$376.63 / $708.66 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,538.00 / $9,948.00 / $15,579.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$906.53 / $1,059.34 / $1,708.69
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.46 / $421.46 / $722.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$376.63 / $5,266.00 / $14,978.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.46 / $421.46 / $722.20
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$681.20 / $985.69 / $1,239.05
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,623.50 / $12,623.50 / $12,623.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,635.00 / $11,608.00 / $13,980.00