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Wisconsin rates for HCPCS 99455

Work related or medical disability examination by the treating physician that includes: Completion of a medical history commensurate with the patient's condition; Performance of an examination commensurate with the patient's condition; Formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; Development of future medical treatment plan; and Completion of necessary documentation/certificates and report.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.95 / $84.95 / $84.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.19 / $84.95 / $125.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $85.10 / $158.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.00 / $202.00 / $9,999.99
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.19 / $84.95 / $207.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.19 / $84.95 / $203.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$451.00 / $451.00 / $451.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $293.01
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.19 / $84.95 / $207.48
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$451.00 / $451.00 / $451.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$451.00 / $451.00 / $451.00