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Michigan rates for HCPCS 25455

Epiphyseal arrest by epiphysiodesis or stapling; distal radius AND ulna

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$938.04 / $4,112.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.80 / $938.04 / $974.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,322.81 / $3,900.01 / $5,283.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.75 / $1,118.47 / $1,866.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$539.52 / $843.85 / $1,557.16
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$667.27 / $4,112.00 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$667.27 / $768.55 / $1,122.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.50 / $509.08 / $876.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,500.00 / $7,519.00 / $10,351.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.25 / $856.40 / $1,120.67