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Wisconsin rates for HCPCS 25490

Proph Tx N/P/Pltwr W/Wo Methylacrylate Radius

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$700.08 / $1,478.81 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$670.60 / $731.00 / $3,272.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,287.00 / $13,743.77 / $21,606.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$685.70 / $1,522.88 / $4,291.64
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
$1,869.82 / $2,185.04 / $3,351.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,150.19 / $2,864.17 / $3,254.74
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$700.08 / $977.88 / $1,643.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$700.08 / $1,444.05 / $13,250.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$813.48 / $1,540.26 / $5,987.91
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.47 / $421.51 / $1,392.12
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$700.08 / $977.88 / $1,643.13
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,435.85 / $1,749.53 / $2,611.69
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
$1,340.02 / $3,422.80 / $5,987.91
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,309.42 / $2,309.42 / $2,309.42
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,077.00 / $3,543.70 / $4,558.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,301.00 / $11,608.00 / $13,980.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$769.08 / $1,412.85 / $3,114.75