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Wisconsin rates for HCPCS 25628

Open Tx Carpal Scaphoid Navicular Fracture

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$704.34 / $2,657.31 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,287.00 / $13,743.77 / $21,606.00
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
$1,883.34 / $2,200.83 / $3,376.13
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$692.48 / $909.56 / $1,656.68
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$704.34 / $1,439.65 / $15,090.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$692.48 / $909.56 / $1,656.68
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,439.75 / $1,754.28 / $2,618.79
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,213.88 / $7,213.88 / $19,913.50
Quartz
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$1,887.52 / $1,887.52 / $1,887.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,627.00 / $12,373.00 / $15,090.00