go back

Wisconsin rates for HCPCS 28490

Cltx Fx Grt Toe Phlx/Phlg W/O Manj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.48 / $270.08 / $1,894.00
Aetna
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$94.11 / $106.91 / $410.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.33 / $142.55 / $574.16
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
$140.61 / $289.56 / $724.96
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$277.98 / $277.98 / $277.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$393.79 / $460.17 / $705.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.77 / $439.01 / $672.85
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.04 / $163.74 / $307.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.04 / $196.85 / $1,449.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.80 / $316.58 / $1,086.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.95 / $92.82 / $281.96
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.04 / $163.74 / $307.82
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.33 / $353.23 / $506.48
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.02 / $208.02 / $605.96
Quartz
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$416.44 / $416.44 / $416.44
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.55 / $623.29 / $1,086.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.49 / $827.43 / $942.31
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
$146.88 / $283.62 / $627.58