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Wisconsin rates for HCPCS 64738

Transection/Avulsion Inf Alveolar Nrv W/Osteo

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$421.80 / $938.68 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$421.80 / $445.14 / $1,773.06
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,740.00 / $4,780.00 / $7,344.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.24 / $1,018.62 / $2,517.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,189.48 / $1,390.00 / $2,132.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.71 / $1,761.28 / $2,001.45
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$421.80 / $625.79 / $938.68
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$421.80 / $759.24 / $5,261.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$492.62 / $892.08 / $3,951.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.75 / $368.81 / $975.91
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$421.80 / $619.91 / $938.68
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$884.65 / $1,077.91 / $1,609.11
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,900.50 / $1,900.50 / $5,246.20
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$884.85 / $2,219.10 / $3,951.10
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,586.71 / $1,586.71 / $1,586.71
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,471.14 / $2,624.33 / $2,637.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,723.00 / $3,912.00 / $5,865.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.84 / $887.64 / $1,997.19