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Wisconsin rates for HCPCS 25275

Rpr Tendon Sheath Extensor F/Arm&/Wrist W/Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$658.68 / $1,395.34 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,060.00 / $8,139.00 / $11,136.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,462.54 / $3,462.54 / $3,462.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,762.59 / $2,059.73 / $3,159.67
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$658.68 / $900.61 / $1,438.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$658.68 / $1,333.32 / $11,100.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$658.68 / $849.99 / $1,438.60
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,347.45 / $1,641.82 / $2,450.91
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,244.77 / $3,244.77 / $8,957.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,241.00 / $9,837.00 / $12,062.00