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Wisconsin rates for HCPCS G0402

Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.16 / $119.16 / $150.97
Aetna
Facility/Professional
Facility
Modifier
25
Low / Median / High Price
$178.71 / $178.71 / $197.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.29 / $150.97 / $212.50
Aetna
Facility/Professional
Professional
Modifier
25
Low / Median / High Price
$192.57 / $192.57 / $261.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.76 / $235.19 / $444.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$443.35 / $518.09 / $688.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.90 / $230.63 / $420.65
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.16 / $154.22 / $259.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.16 / $152.29 / $262.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.47 / $294.95 / $1,045.69
Medica
Facility/Professional
Professional
Modifier
25
Low / Median / High Price
$321.30 / $321.30 / $321.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.52 / $165.51 / $344.18
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.16 / $154.22 / $262.19
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.40 / $379.06 / $509.03
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$174.07 / $248.84 / $653.54
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.90 / $714.69 / $1,045.69
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.50 / $385.68 / $492.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.69 / $266.43 / $436.39