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Wisconsin rates for HCPCS 77404

Radj Dlvr 1 Area 1/Prll Opsd Ports Smpl 11-19Mev

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $407.38 / $660.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $245.47 / $316.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $524.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $58.88 / $58.88
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $426.58 / $426.58
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $524.81 / $524.81