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Wisconsin rates for HCPCS 54112

Exc Penile Plaque Graft > 5 Cm Length

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,005.19 / $1,919.25 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,139.00 / $15,055.00 / $22,609.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,407.79 / $2,813.70 / $4,538.39
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,005.19 / $1,333.78 / $4,630.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,005.19 / $4,630.83 / $15,743.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,005.19 / $1,333.78 / $4,630.83
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,829.10 / $2,824.41 / $3,326.99
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27,110.45 / $27,110.45 / $27,110.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,217.00 / $11,608.00 / $13,980.00