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Wisconsin rates for HCPCS 15201

Fth/Gft Fr W/Dir Clsr Trnk Ea Addl 20 Sq Cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.23 / $151.54 / $3,119.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.00 / $1,979.00 / $2,601.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$368.56 / $430.69 / $660.69
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.03 / $150.29 / $376.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.44 / $202.08 / $1,513.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.03 / $150.29 / $376.44
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.96 / $258.92 / $450.54
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.11 / $189.93 / $345.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,008.00 / $1,423.00 / $2,202.90