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Wisconsin rates for HCPCS 28555

Open Treatment Tarsal Bone Dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$650.42 / $1,345.99 / $3,119.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,287.00 / $13,743.77 / $21,606.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,161.69 / $11,161.69 / $11,161.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,281.64 / $2,666.27 / $4,090.13
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$628.00 / $910.60 / $1,724.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$650.42 / $1,054.04 / $12,741.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$628.00 / $900.00 / $1,724.28
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,469.38 / $2,007.50 / $2,861.09
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,129.64 / $3,129.64 / $10,346.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,627.00 / $12,373.00 / $15,090.00