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Wisconsin rates for HCPCS 53515

Urtorr Sutr Urethral Wnd/Inj Prostatomembranous

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$802.35 / $1,631.47 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$753.64 / $818.74 / $2,648.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,538.00 / $9,720.00 / $15,579.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$781.47 / $2,072.21 / $5,417.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,049.15 / $2,394.59 / $3,862.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,080.40 / $2,476.84 / $3,279.96
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$797.61 / $1,056.83 / $1,805.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$802.35 / $4,240.00 / $12,631.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$923.02 / $2,134.91 / $5,350.32
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.30 / $667.78 / $1,711.38
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$801.56 / $1,094.06 / $1,805.50
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,554.15 / $2,399.85 / $3,222.30
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,302.50 / $14,302.50 / $14,302.50
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,103.76 / $3,881.65 / $9,010.07
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,058.46 / $4,058.46 / $4,058.46
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,782.30 / $4,683.43 / $4,683.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,240.00 / $10,264.00 / $12,705.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$925.82 / $2,764.82 / $4,669.79