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Wisconsin rates for HCPCS 14301

Adjnt Tis Trnsfr/Reargmt Any Area 30.1-60 Sq Cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$721.93 / $2,690.22 / $6,461.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$721.93 / $1,055.81 / $4,833.00
Aetna
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$98.52 / $624.02 / $1,501.10
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,060.00 / $7,344.00 / $10,517.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,035.36 / $2,154.58 / $4,589.71
Anthem BCBS
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$144.94 / $323.54 / $656.40
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$785.66 / $788.47 / $1,104.39
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$986.58 / $1,085.24 / $1,359.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,848.44 / $3,328.63 / $5,106.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$955.63 / $1,576.93 / $2,774.86
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$844.66 / $1,303.16 / $2,959.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$911.32 / $2,341.32 / $10,843.00
Medica
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$397.38 / $397.38 / $397.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,049.52 / $1,948.22 / $6,420.24
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.48 / $623.76 / $1,998.23
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$844.66 / $1,303.16 / $2,959.74
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,890.00 / $2,575.42 / $3,583.32
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,663.67 / $2,223.48 / $6,085.56
Quartz
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$166.37 / $222.35 / $397.38
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,031.93 / $3,623.58 / $8,026.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,908.83 / $3,665.84 / $4,614.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,241.00 / $9,837.00 / $12,062.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$963.82 / $1,606.65 / $4,093.98