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Wisconsin rates for HCPCS G0121

Colorectal Cancer Screening; Colonoscopy On Individual Not Meeting Criteria For High Risk (Special Coverage Instructions Apply)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,871.02 / $3,374.39 / $7,054.04
Aetna
Facility/Professional
Facility
Modifier
52
Low / Median / High Price
$81.26 / $81.26 / $154.19
Aetna
Facility/Professional
Facility
Modifier
53
Low / Median / High Price
$32.50 / $61.68 / $154.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.57 / $334.76 / $2,490.50
Aetna
Facility/Professional
Professional
Modifier
53
Low / Median / High Price
$35.65 / $81.31 / $194.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,139.00 / $2,419.00 / $4,441.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.06 / $478.01 / $1,776.65
Anthem BCBS
Facility/Professional
Professional
Modifier
53
Low / Median / High Price
$85.58 / $286.08 / $873.99
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.82 / $165.74 / $261.50
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.86 / $227.99 / $463.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$906.53 / $1,059.34 / $1,625.07
Cigna
Facility/Professional
Facility
Modifier
52
Low / Median / High Price
$194.94 / $194.94 / $194.94
Cigna
Facility/Professional
Facility
Modifier
53
Low / Median / High Price
$48.74 / $48.74 / $48.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.69 / $468.28 / $1,241.16
Cigna
Facility/Professional
Professional
Modifier
53
Low / Median / High Price
$133.43 / $246.00 / $656.57
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.57 / $308.39 / $439.63
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.50 / $277.50 / $277.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.58 / $318.35 / $2,903.60
Medica
Facility/Professional
Facility
Modifier
52
Low / Median / High Price
$664.86 / $664.86 / $664.86
Medica
Facility/Professional
Facility
Modifier
53
Low / Median / High Price
$166.21 / $166.21 / $166.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.08 / $1,016.63 / $2,208.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.76 / $274.03 / $588.93
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.57 / $308.39 / $433.31
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.50 / $277.50 / $277.50
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$379.80 / $694.39 / $1,137.40
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.68 / $1,065.09 / $1,065.09
Quartz
Facility/Professional
Facility
Modifier
52
Low / Median / High Price
$194.94 / $664.86 / $664.86
Quartz
Facility/Professional
Facility
Modifier
53
Low / Median / High Price
$48.74 / $166.21 / $166.21
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.75 / $1,182.76 / $2,208.13
Quartz
Facility/Professional
Professional
Modifier
53
Low / Median / High Price
$346.42 / $346.42 / $656.57
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$476.20 / $911.11 / $1,722.14
Security Health
Facility/Professional
Professional
Modifier
53
Low / Median / High Price
$143.75 / $237.97 / $515.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,367.00 / $2,910.00 / $4,155.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$341.68 / $702.81 / $1,447.15