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Wisconsin rates for HCPCS V2790

Amniotic Membrane For Surgical Reconstruction, Per Procedure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$404.13 / $404.13 / $404.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.48 / $404.13 / $439.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.00 / $350.00 / $497.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.51 / $104.51 / $129.72
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$404.13 / $404.13 / $422.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$404.13 / $404.13 / $644.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$404.13 / $404.13 / $424.34
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $100.00 / $644.99
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.51 / $104.51 / $104.51