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Wisconsin rates for HCPCS 81503

Oncology (ovarian), biochemical assays of five proteins (CA-125, apolipoprotein A1, beta-2 microglobulin, transferrin, and pre-albumin), utilizing serum, algorithm reported as a risk score

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,995.26 / $2,454.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $741.31 / $1,258.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $2,398.83 / $2,454.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $354.81 / $3,548.13
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $2,884.03 / $4,570.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,348.96 / $2,818.38
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $1,778.28 / $5,128.61
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,370.32 / $5,370.32 / $6,025.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $851.14 / $3,162.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $537.03 / $3,235.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $70.79 / $891.25
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,089.30 / $2,951.21
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $1,778.28 / $4,265.80
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $4,466.84 / $4,466.84
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $1,905.46 / $1,905.46
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $4,897.79 / $6,309.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $724.44 / $1,071.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $537.03 / $1,479.11