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Wisconsin rates for HCPCS 28202

Repair, tendon, flexor, foot; secondary with free graft, each tendon (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $1,258.93 / $13,489.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,585.78 / $15,135.61 / $26,302.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,862.09 / $3,090.30
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $831.76 / $4,677.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $870.96 / $7,762.47
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,318.26 / $1,995.26
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,772.37 / $18,197.01 / $26,915.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,897.79 / $7,413.10 / $9,120.11