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Wisconsin rates for HCPCS 59121

Tx Ectopic Pregnancy W/O Salping&/Oophorectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$923.21 / $1,583.66 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.99 / $923.21 / $2,645.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,538.00 / $10,082.00 / $15,579.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$743.09 / $1,943.13 / $3,405.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,004.09 / $2,341.94 / $3,777.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,090.97 / $2,297.21 / $2,651.57
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$844.62 / $1,040.33 / $2,562.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$844.62 / $2,562.98 / $11,598.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$899.47 / $1,910.60 / $3,738.47
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.62 / $460.12 / $1,555.81
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$815.70 / $1,040.33 / $2,562.98
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,604.85 / $2,219.14 / $2,803.80
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,629.63 / $6,629.63 / $6,629.63
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,125.36 / $3,747.80 / $5,892.48
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,438.97 / $1,438.97 / $1,438.97
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,517.08 / $2,421.39 / $2,421.39
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,241.00 / $9,837.00 / $12,062.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$901.75 / $2,208.46 / $3,284.95