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Wisconsin rates for HCPCS 81504

Oncology Tissue Of Origin Similar Scor Algorithm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$624.00 / $780.00 / $1,159.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.40 / $494.00 / $790.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,118.00 / $1,352.00 / $1,430.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.00 / $520.00 / $2,227.27
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,270.83 / $1,270.83 / $1,320.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,430.98 / $1,672.21 / $2,565.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$597.61 / $1,400.26 / $1,591.20
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.40 / $624.00 / $1,820.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$468.00 / $624.00 / $1,820.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.00 / $312.00 / $1,603.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $260.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.40 / $624.00 / $1,820.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$988.42 / $1,268.39 / $1,739.53
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,040.00 / $2,470.00 / $2,470.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$754.00 / $2,600.00 / $2,600.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,107.35 / $1,107.35 / $1,107.35
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,511.23 / $2,839.20 / $2,839.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.04 / $312.00 / $1,092.00