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Wisconsin rates for HCPCS 12004

Simple Rpr Scalp/Neck/Ax/Genit/Trunk 7.6-12.5cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.04 / $329.78 / $1,089.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.17 / $110.74 / $380.72
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,139.00 / $2,479.00 / $4,441.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.87 / $219.54 / $491.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$348.73 / $407.52 / $625.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.52 / $180.96 / $385.01
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.64 / $153.41 / $364.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.95 / $211.92 / $1,455.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.57 / $248.30 / $619.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.91 / $95.42 / $221.50
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.64 / $153.41 / $364.80
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.16 / $248.70 / $431.64
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.31 / $180.85 / $509.10
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.16 / $350.90 / $1,072.34
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.80 / $300.91 / $563.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$785.00 / $1,370.00 / $2,202.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.99 / $232.05 / $495.61