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Wisconsin rates for HCPCS 13121

Repair Complex Scalp/Arm/Leg 2.6-7.5 Cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.92 / $871.97 / $10,705.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.92 / $399.93 / $1,759.50
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
$374.46 / $774.67 / $1,658.20
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.30 / $235.55 / $326.45
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.54 / $426.29 / $521.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,139.02 / $1,331.03 / $2,041.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.89 / $658.66 / $1,178.75
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$255.74 / $496.05 / $1,142.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$272.27 / $698.70 / $1,756.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$414.66 / $769.97 / $1,914.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.98 / $310.57 / $790.03
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$255.74 / $496.05 / $1,142.19
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$565.73 / $871.26 / $1,369.56
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$497.01 / $664.25 / $1,802.64
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$454.82 / $1,272.50 / $3,161.36
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$496.60 / $1,095.26 / $1,831.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,034.00 / $1,423.00 / $2,202.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$391.32 / $604.41 / $1,583.99