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Wisconsin rates for HCPCS 15261

Fth/Gft Free W/Dir Clsr N/E/E/L Ea Addl 20 Sq Cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.60 / $272.63 / $3,119.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.60 / $173.91 / $476.62
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.00 / $1,979.00 / $2,601.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.17 / $390.81 / $813.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$540.66 / $631.82 / $969.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.33 / $285.73 / $563.55
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.59 / $241.23 / $556.62
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.07 / $310.77 / $1,590.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.03 / $402.59 / $2,089.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.44 / $190.84 / $443.01
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.59 / $241.23 / $556.62
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.95 / $445.60 / $660.98
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$255.67 / $341.70 / $610.08
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.65 / $664.70 / $2,266.96
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$304.22 / $566.24 / $873.67
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
$188.04 / $332.51 / $840.25