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Wisconsin rates for HCPCS C1052

Hemostatic Agent, Gi, Topic

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,376.89 / $6,376.89 / $6,376.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.98 / $660.98 / $660.98
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.98 / $660.98 / $660.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $660.98 / $660.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.98 / $660.98 / $660.98
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,900.00 / $5,900.00 / $5,900.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $100.00