go back

Wisconsin rates for HCPCS Q2028

Injection, sculptra, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.38 / $1.38 / $1.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $645.65 / $676.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.98 / $4.68 / $4.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $0.66 / $0.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.66 / $1.51 / $2.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.85 / $0.95
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.62 / $0.78 / $0.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.62 / $0.78 / $1.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $0.68 / $0.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $54.95 / $85.11
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.66 / $0.66 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $0.66 / $0.66
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $0.68 / $0.91