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Wisconsin rates for HCPCS 25316

Flexor Origin Slide F/Arm&/Wrst Tendon Transfe

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$887.29 / $1,870.99 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.46 / $925.13 / $4,163.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,878.00 / $14,586.00 / $21,869.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$872.03 / $2,047.59 / $5,451.84
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,560.77 / $7,560.77 / $7,560.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,363.64 / $2,762.10 / $4,237.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,441.69 / $3,625.52 / $4,119.91
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$887.29 / $1,330.48 / $1,960.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$887.29 / $1,830.40 / $15,090.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,030.60 / $1,929.48 / $7,097.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.47 / $556.26 / $1,751.19
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$887.29 / $1,285.67 / $1,960.91
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,820.65 / $2,218.39 / $3,311.62
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,213.88 / $7,213.88 / $19,913.50
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,696.22 / $4,355.10 / $7,097.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,933.76 / $2,933.76 / $2,933.76
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,847.43 / $4,504.76 / $5,769.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,627.00 / $12,373.00 / $15,090.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$987.67 / $1,952.35 / $4,179.42