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Wisconsin rates for HCPCS 28455

Tx Tarsal Bone Fx Xcp Talus&Calcn W/Manj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$262.58 / $492.57 / $1,894.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.36 / $295.06 / $1,198.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,183.00 / $3,483.00 / $5,962.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.45 / $605.96 / $1,593.36
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$463.64 / $463.64 / $463.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$701.07 / $819.26 / $1,256.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.13 / $828.09 / $1,210.45
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$260.30 / $345.22 / $580.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$262.58 / $422.00 / $1,455.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.66 / $631.35 / $1,970.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.75 / $185.44 / $488.92
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$260.30 / $345.22 / $580.29
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$513.50 / $632.16 / $934.02
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.11 / $293.11 / $1,103.92
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$483.41 / $1,254.05 / $1,970.27
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$854.63 / $854.63 / $960.87
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$846.30 / $1,517.51 / $1,695.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,034.00 / $1,423.00 / $2,202.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.45 / $581.07 / $1,346.40