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Wisconsin rates for HCPCS A4641

Radiopharmaceutical Diagnostic Not Otherwise Classified

Insurance Carrier
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.34 / $79.34 / $79.34
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.17 / $106.17 / $116.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.17 / $116.70 / $455.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.13 / $125.13 / $125.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.17 / $106.17 / $116.70
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.34 / $79.34 / $79.34