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Wisconsin rates for HCPCS 43501

Gastrotomy; with suture repair of bleeding ulcer

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $2,630.27 / $14,454.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,317.64 / $13,803.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $3,890.45 / $6,165.95
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,737.80 / $8,511.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,778.28 / $5,888.44
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,951.21 / $4,570.88
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $12,022.64 / $12,022.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $6,165.95 / $19,498.45