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Wisconsin rates for HCPCS 21255

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Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,328.39 / $2,763.25 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,261.50 / $1,328.39 / $6,411.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,293.00 / $10,261.00 / $16,653.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,362.61 / $3,065.51 / $7,854.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,516.17 / $4,108.92 / $6,303.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,964.44 / $5,371.36 / $6,103.81
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,311.25 / $1,769.44 / $2,935.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,311.25 / $2,729.66 / $13,250.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,484.36 / $2,696.17 / $10,981.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.60 / $779.67 / $2,541.08
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,311.25 / $1,769.44 / $2,935.74
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,605.19 / $3,174.34 / $4,738.66
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,498.64 / $12,498.64 / $12,498.64
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,513.01 / $6,706.90 / $10,981.50
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,416.97 / $4,416.97 / $4,416.97
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,410.64 / $6,888.79 / $8,548.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,301.00 / $11,608.00 / $13,980.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,456.66 / $2,653.02 / $6,103.28