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Wisconsin rates for HCPCS C9364

Porcine Implant Permacol Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.30 / $17.30 / $17.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.30 / $17.30 / $18.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.80 / $18.39 / $20.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.39 / $18.39 / $18.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.39 / $18.39 / $18.39
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.30 / $17.30 / $25.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.30 / $17.52 / $31.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.19 / $82.19 / $82.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.30 / $17.30 / $25.95
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,900.00 / $5,900.00 / $5,900.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $85.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.39 / $22.93 / $82.19