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Wisconsin rates for HCPCS 61623

Evasc Temp Balloon Artl Occlusion Head/Neck

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$496.02 / $1,097.57 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,080.00 / $16,493.00 / $23,358.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,371.50 / $1,602.71 / $2,585.12
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$496.02 / $727.98 / $1,048.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$536.59 / $8,452.00 / $21,512.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$496.02 / $727.98 / $1,048.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,124.50 / $1,730.00 / $2,387.25
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34,401.94 / $34,401.94 / $34,401.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,452.00 / $14,566.00 / $19,562.00