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Wisconsin rates for HCPCS 15050

Pinch Graft 1/Mlt Sm Ulcer Tip/Oth Ar Up To 2 Cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$385.57 / $944.39 / $3,119.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.57 / $500.17 / $1,530.57
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
$545.07 / $1,149.96 / $2,449.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,553.53 / $1,815.42 / $2,784.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.07 / $827.60 / $1,507.00
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$435.24 / $694.95 / $1,599.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$453.07 / $935.31 / $1,756.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$534.58 / $1,079.85 / $3,381.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.63 / $347.60 / $1,097.57
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$435.24 / $694.95 / $1,599.48
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,008.21 / $1,393.02 / $1,910.46
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$885.63 / $1,183.64 / $2,145.60
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$571.22 / $2,185.40 / $4,336.64
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$847.19 / $847.19 / $1,107.73
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.28 / $1,938.90 / $2,503.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,008.00 / $1,423.00 / $2,202.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$541.96 / $907.62 / $2,366.46