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Wisconsin rates for HCPCS A4397

Irrigation supply; sleeve, each

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.59 / $14.79 / $23.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $10.00 / $11.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $89.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $21.38 / $21.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $58.88 / $58.88
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $70.79 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $23.44 / $23.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.57 / $2.82 / $4.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.82 / $3.09 / $3.31