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Wisconsin rates for HCPCS 58976

Gamete Zygote/Embryo Fallopian Transfer Any Meth

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.68 / $521.64 / $1,894.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.81 / $252.84 / $829.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,139.00 / $2,479.00 / $4,441.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.11 / $621.08 / $1,347.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$667.73 / $780.30 / $1,258.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.70 / $613.13 / $970.41
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219.30 / $278.99 / $824.57
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.68 / $489.99 / $1,789.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.24 / $611.25 / $1,222.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $426.62 / $709.79
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219.30 / $278.99 / $824.57
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$470.68 / $656.37 / $869.01
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,719.90 / $1,719.90 / $1,719.90
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.74 / $1,029.00 / $3,100.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.45 / $270.45 / $335.28
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.52 / $1,330.22 / $1,647.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,008.00 / $1,507.00 / $2,202.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.93 / $727.03 / $1,071.52