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Wisconsin rates for HCPCS 69637

Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis [PORP], total ossicular replacement prosthesis [TORP])

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.12 / $2,879.78 / $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
$3,718.92 / $4,345.85 / $7,009.71
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.12 / $1,884.11 / $2,751.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,334.69 / $5,266.00 / $15,126.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.12 / $1,955.60 / $2,751.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,737.15 / $4,221.80 / $4,978.67
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,547.20 / $16,547.20 / $16,547.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,217.00 / $11,608.00 / $13,980.00