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Wisconsin rates for HCPCS L8658

Interphalangeal Joint Spacer Silicone Or Equal Each. (Rvsd 1/1/04)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.80 / $184.80 / $184.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.85 / $184.80 / $316.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.32 / $402.95 / $666.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.68 / $340.68 / $450.57
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.54 / $783.92 / $783.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$228.90 / $984.92 / $1,529.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.57 / $539.12 / $693.28
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.98 / $277.20 / $421.27
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.74 / $366.32 / $439.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.80 / $366.32 / $1,907.92
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.32 / $244.76 / $402.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.98 / $282.74 / $421.27
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.74 / $366.32 / $439.58
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.32 / $563.75 / $1,096.04
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$228.90 / $715.46 / $1,907.92
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.57 / $228.90 / $2,432.33
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.32 / $366.32 / $366.32
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.32 / $366.32 / $366.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.94 / $219.79 / $366.32