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Wisconsin rates for HCPCS 43121

Prtl Esophagec W/Wo Prox Gastrec/Pyloroplasty

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,954.07 / $5,480.66 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,580.67 / $2,954.07 / $8,045.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,538.00 / $10,908.00 / $18,360.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,663.83 / $6,059.63 / $15,638.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,846.71 / $8,000.92 / $12,273.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,091.96 / $9,119.77 / $10,981.39
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,499.80 / $3,098.72 / $5,307.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,490.39 / $3,402.29 / $6,180.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,829.01 / $6,157.15 / $20,305.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.74 / $2,464.55 / $6,080.91
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,499.80 / $3,098.72 / $5,307.40
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,076.00 / $6,769.69 / $11,109.34
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,227.34 / $51,799.52 / $51,799.52
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,766.10 / $13,319.05 / $20,305.84
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,861.03 / $9,861.03 / $9,861.03
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,872.43 / $13,408.29 / $13,408.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,480.00 / $7,565.00 / $19,003.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,711.92 / $5,568.49 / $12,067.06