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Wisconsin rates for HCPCS 0354T

Optical coherence tomography of breast, surgical cavity; interpretation and report, real-time or referred

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.09 / $200.00 / $200.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.67 / $79.09 / $450.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.13 / $1,249.70 / $5,215.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,243.60 / $3,458.03 / $3,458.03
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.50 / $79.09 / $435.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.50 / $89.78 / $995.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,030.79 / $2,300.67 / $4,183.71
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.50 / $79.09 / $612.14
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.12 / $124.65 / $1,905.65
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.63 / $995.80 / $995.80
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$406.00 / $3,657.26 / $3,657.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$896.34 / $2,009.46 / $4,183.71