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Wisconsin rates for HCPCS 25491

Proph Tx N/P/Pltwr W/Wo Methylmethacrylate Ulna

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$718.78 / $1,518.30 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$666.75 / $737.07 / $2,956.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,287.00 / $15,141.00 / $22,609.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$705.44 / $1,658.72 / $4,410.32
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,551.22 / $14,551.22 / $14,551.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,919.39 / $2,242.94 / $3,440.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,181.54 / $2,940.43 / $3,341.40
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$718.78 / $987.62 / $1,588.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$718.78 / $1,450.82 / $13,250.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$836.70 / $1,583.64 / $6,188.07
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
$718.78 / $937.70 / $1,588.50
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,476.15 / $1,798.63 / $2,685.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,275.12 / $17,275.12 / $47,686.95
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,375.70 / $3,519.20 / $6,188.07
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,373.31 / $2,373.31 / $2,373.31
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,136.81 / $3,641.66 / $4,679.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,266.00 / $11,608.00 / $16,437.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$798.47 / $1,541.41 / $3,377.24