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Wisconsin rates for HCPCS 25492

Proph Tx N/P/Pltwr W/Wo Methylmecrylate Rad&Ul

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$878.50 / $1,853.01 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$842.67 / $916.22 / $4,119.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,169.00 / $8,408.00 / $12,444.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$862.76 / $2,027.31 / $5,165.06
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,462.54 / $3,462.54 / $3,462.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,342.01 / $2,736.83 / $4,198.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,363.76 / $3,590.38 / $4,079.98
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$878.50 / $1,169.32 / $1,941.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$878.50 / $1,770.65 / $13,120.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,015.16 / $1,905.86 / $6,712.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.47 / $556.26 / $1,751.19
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$878.50 / $1,149.41 / $1,941.49
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,802.45 / $2,196.21 / $3,278.52
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,244.77 / $3,244.77 / $8,957.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,679.78 / $4,309.45 / $6,712.56
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,904.64 / $2,904.64 / $2,904.64
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,612.50 / $4,458.09 / $5,713.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,266.00 / $11,608.00 / $13,980.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$948.08 / $1,736.92 / $3,921.60