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Maine rates for HCPCS 25455

Epiphyseal arrest by epiphysiodesis or stapling; distal radius AND ulna

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $831.76 / $1,949.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,096.48 / $1,584.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,023.29 / $1,659.59
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,023.29 / $1,949.84
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,023.29 / $2,089.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $870.96 / $1,584.89