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Wisconsin rates for HCPCS 19301

Mastectomy Partial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,311.05 / $5,212.18 / $16,451.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$534.72 / $837.32 / $3,188.00
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
$613.63 / $1,578.26 / $2,929.41
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$628.72 / $962.09 / $962.09
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.19 / $962.09 / $1,487.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,650.85 / $1,929.15 / $3,111.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,165.36 / $1,631.80 / $2,638.57
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$534.72 / $837.46 / $1,437.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.96 / $4,685.18 / $8,783.00
Medica
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$9,681.12 / $9,681.12 / $9,681.12
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$634.23 / $1,422.04 / $2,702.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.69 / $396.03 / $1,259.86
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$534.72 / $837.46 / $1,437.77
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,300.65 / $1,749.55 / $2,365.78
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,723.79 / $8,723.79 / $8,723.79
Quartz
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$826.90 / $826.90 / $826.90
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,227.85 / $3,083.35 / $4,805.92
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,021.30 / $2,713.49 / $2,713.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,918.00 / $6,477.00 / $8,384.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$647.25 / $1,863.53 / $2,702.56