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Wisconsin 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
$707.95 / $1,513.56 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $741.31 / $1,862.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,317.64 / $14,125.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,412.54 / $3,548.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $2,238.72 / $3,548.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $2,951.21 / $3,388.44
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $1,348.96 / $5,495.41
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,737.80 / $2,238.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $1,479.11 / $13,182.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,288.25 / $5,623.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,659.59 / $2,511.89
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $6,025.60 / $8,912.51
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $3,467.37 / $5,754.40
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,344.23 / $2,344.23
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $3,981.07 / $4,677.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,585.78 / $12,022.64 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,096.48 / $2,951.21