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Wisconsin rates for HCPCS 54120

Amputation Penis Partial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$680.55 / $1,302.57 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,060.00 / $8,139.00 / $11,136.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,639.14 / $1,915.46 / $3,089.57
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$636.80 / $869.16 / $1,273.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$680.55 / $4,240.00 / $11,598.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$680.55 / $869.16 / $1,273.59
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,240.84 / $1,916.06 / $2,257.01
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,388.90 / $9,388.90 / $9,388.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,241.00 / $9,837.00 / $12,062.00