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Wisconsin rates for HCPCS 28430

Closed Tx Talus Fracture W/O Manipulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.35 / $451.62 / $1,894.00
Aetna
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$158.51 / $181.11 / $687.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.80 / $241.48 / $968.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,139.00 / $2,479.00 / $4,441.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.06 / $487.72 / $1,232.30
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.44 / $319.44 / $319.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.52 / $771.87 / $1,184.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.43 / $801.47 / $1,133.41
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.35 / $284.86 / $514.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.25 / $339.14 / $1,449.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.05 / $529.66 / $1,835.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.53 / $182.42 / $484.25
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.35 / $283.50 / $514.30
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.21 / $595.58 / $853.97
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$264.92 / $264.92 / $1,023.04
Quartz
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$701.49 / $701.49 / $701.49
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.22 / $1,049.94 / $1,835.84
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$673.01 / $1,390.12 / $1,587.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,008.00 / $1,370.00 / $2,202.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.21 / $483.76 / $1,050.00