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Wisconsin rates for HCPCS 28805

Amputation Foot Transmetarsal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$690.30 / $1,452.22 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,060.00 / $7,344.00 / $10,517.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,822.97 / $2,130.28 / $3,267.90
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$690.30 / $966.42 / $1,613.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$690.30 / $1,417.67 / $8,296.28
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$690.30 / $966.42 / $1,613.58
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,383.20 / $1,685.38 / $2,515.92
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,768.60 / $7,768.60 / $7,768.60
Quartz
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$736.98 / $736.98 / $736.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,918.00 / $6,477.00 / $8,384.00