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Wisconsin rates for HCPCS 28515

Cltx Fx Phlx/Phlg Oth/Thn Grt Toe W/Manj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.02 / $309.62 / $1,894.00
Aetna
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$108.02 / $123.83 / $473.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.03 / $165.11 / $630.41
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
$159.97 / $288.02 / $874.15
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$292.86 / $292.86 / $292.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$455.97 / $532.83 / $817.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.55 / $505.41 / $765.35
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.16 / $195.47 / $354.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.02 / $236.13 / $1,449.00
Medica
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$629.09 / $629.09 / $629.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.79 / $357.17 / $1,264.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.53 / $120.84 / $338.03
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.16 / $193.18 / $354.20
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.31 / $405.50 / $581.42
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.98 / $225.98 / $697.92
Quartz
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$474.73 / $474.73 / $474.73
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.72 / $725.22 / $1,264.80
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.41 / $955.51 / $1,096.39
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
$168.54 / $317.48 / $719.16