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Wisconsin rates for HCPCS 74190

Peritoneogram Rs&I

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$32.86 / $45.41 / $45.41
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$56.77 / $66.34 / $88.17
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$129.00 / $129.00 / $129.00
Quartz
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$100.00 / $129.00 / $129.00