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Wisconsin rates for HCPCS 15101

Split Agrft T/A/L Ea 100 Cm/Ea 1% Bdy Inft/Chld

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.95 / $218.16 / $6,461.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,479.00 / $5,692.00 / $7,344.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$484.80 / $566.53 / $869.07
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.01 / $213.30 / $501.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.35 / $290.52 / $1,513.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.01 / $213.30 / $501.66
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.19 / $372.11 / $597.15
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.59 / $273.43 / $501.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,034.00 / $1,423.00 / $2,202.90