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Wisconsin rates for HCPCS Q2028

Injection, sculptra, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.62 / $0.62 / $1.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $0.67 / $651.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.85 / $2.15 / $2.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $0.66 / $0.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.66 / $1.79 / $2.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $0.77 / $0.94
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
$0.67 / $0.67 / $0.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.03 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.62 / $0.78 / $0.78
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.00 / $90.00 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $0.66 / $0.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.67 / $0.67 / $0.92