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Wisconsin rates for HCPCS 43501

Gastrotomy W/Suture Repair Bleeding Ulcer

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,419.26 / $2,645.89 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,060.00 / $7,979.00 / $13,297.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,326.03 / $3,886.73 / $5,962.35
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.70 / $1,660.53 / $2,835.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.70 / $1,814.24 / $4,821.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.61 / $1,660.53 / $2,785.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,435.40 / $3,248.01 / $5,369.86
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,540.80 / $12,474.64 / $12,474.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,203.00 / $6,032.00 / $19,003.00