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Wisconsin rates for HCPCS 54111

Exc Penile Plaque Graft &/5 Cm Length

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$857.95 / $1,638.16 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$806.42 / $857.95 / $2,665.50
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
$785.54 / $2,080.28 / $4,557.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,056.36 / $2,403.01 / $3,875.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,084.82 / $2,487.41 / $3,291.41
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$857.95 / $1,099.76 / $4,308.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$857.95 / $4,308.35 / $14,978.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$929.61 / $1,918.07 / $4,227.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.30 / $658.60 / $1,711.38
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$857.95 / $1,099.76 / $4,308.35
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,560.65 / $2,409.88 / $2,838.70
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
$1,108.47 / $3,903.50 / $5,951.76
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,175.48 / $2,175.48 / $2,175.48
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,498.15 / $3,851.02 / $3,851.02
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
$928.87 / $2,292.00 / $3,907.25