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Wisconsin rates for HCPCS 28264

Capsulotomy Midtarsal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.56 / $1,420.07 / $3,276.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,740.00 / $4,780.00 / $11,302.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,942.50 / $1,942.50 / $1,942.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,298.76 / $2,686.28 / $4,120.82
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$674.17 / $1,072.08 / $1,826.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.79 / $1,256.00 / $11,733.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$674.17 / $1,072.08 / $1,826.97
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,547.07 / $2,126.60 / $3,030.84
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,722.47 / $1,722.47 / $3,171.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,729.00 / $11,608.00 / $13,980.00