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Wisconsin rates for HCPCS 95875

Ischemic Limb Xers Tst Spec Acquisj Metab

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.66 / $147.99 / $235.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.07 / $195.56 / $533.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.49 / $310.89 / $427.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.83 / $313.11 / $880.77
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.38 / $91.28 / $188.51
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.40 / $277.67 / $396.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.25 / $650.65 / $880.77
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.04 / $533.36 / $627.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.38 / $271.56 / $487.99