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Wisconsin rates for HCPCS L2628

Addition To Lower Extremity Pelvic Control Metal Frame Reciprocating Hip Joint And Cables

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$952.16 / $952.16 / $952.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$952.16 / $1,049.09 / $2,050.05
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,887.48 / $2,076.23 / $3,435.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,755.36 / $1,755.36 / $2,321.60
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,357.85 / $4,039.21 / $4,039.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,179.41 / $3,902.42 / $7,878.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$860.97 / $2,735.16 / $3,572.20
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$607.91 / $1,428.24 / $2,170.60
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,080.73 / $1,887.48 / $2,264.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$952.16 / $1,981.85 / $10,013.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$855.00 / $1,098.58 / $2,055.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $1,270.80
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$607.91 / $1,428.24 / $2,170.60
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,080.73 / $1,887.48 / $2,264.98
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,887.48 / $2,904.76 / $5,649.83
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,179.41 / $3,686.48 / $10,013.70
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$860.97 / $1,179.41 / $12,532.82
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,887.48 / $1,887.48 / $1,887.48
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,507.10 / $1,887.48 / $1,887.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$737.30 / $954.30 / $1,804.81