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Wisconsin rates for HCPCS 25624

Closed treatment of carpal scaphoid (navicular) fracture; with manipulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $954.99 / $3,090.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $489.78 / $1,148.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $4,570.88 / $7,079.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $912.01 / $2,187.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $1,548.82 / $2,511.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $1,445.44 / $2,344.23
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $676.08 / $3,548.13
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,148.15 / $1,412.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $707.95 / $3,630.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $933.25 / $3,715.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $562.34
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,288.25 / $1,819.70
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $3,235.94 / $4,786.30
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $2,290.87 / $3,715.35
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $1,621.81
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $2,884.03 / $3,235.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $2,884.03 / $5,011.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $691.83 / $1,862.09