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Wisconsin rates for HCPCS 87301

Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; adenovirus enteric types 40/41

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.13 / $26.92 / $33.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.91 / $10.00 / $14.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $32.36 / $33.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.89 / $5.89 / $47.86
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.12 / $9.12 / $9.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.11 / $38.90 / $61.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.49 / $16.98 / $37.15
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $26.30 / $95.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.55 / $11.22 / $70.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.24 / $10.00 / $26.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.23 / $23.44 / $64.57
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $30.90 / $51.29
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $25.70 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.31 / $7.76 / $11.75
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $12.30 / $25.70
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $12.30 / $66.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.12 / $10.72 / $14.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $9.77 / $26.92