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Wisconsin rates for HCPCS 84081

Phosphatidylglycerol

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.82 / $24.78 / $36.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.55 / $15.69 / $64.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.52 / $42.95 / $45.43
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.16 / $8.16 / $68.34
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.27 / $44.84 / $46.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.06 / $52.65 / $80.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $44.48 / $50.55
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.72 / $14.72 / $19.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.55 / $14.87 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.91 / $16.52 / $45.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.26 / $32.39 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.72 / $14.72 / $19.82
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.19 / $40.39 / $186.68
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.04 / $33.04 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.76 / $10.94 / $16.20
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.00 / $17.00 / $35.18
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.00 / $17.00 / $90.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.91 / $16.52 / $48.49