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Wisconsin rates for HCPCS 25630

Cltx Carpal Bone Fx W/O Manj Each Bone

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$285.95 / $612.25 / $1,894.00
Aetna
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$214.47 / $231.30 / $881.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.95 / $320.19 / $1,315.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,139.00 / $2,479.00 / $4,441.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$293.20 / $659.92 / $1,659.65
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.44 / $319.44 / $319.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$840.75 / $982.48 / $1,507.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.86 / $937.49 / $1,446.40
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$272.11 / $360.83 / $680.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$272.11 / $439.74 / $1,449.00
Medica
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$1,473.00 / $1,473.00 / $1,473.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.76 / $673.11 / $2,350.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.65 / $182.56 / $593.82
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$272.11 / $360.83 / $680.28
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$631.79 / $769.82 / $1,103.80
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$264.92 / $264.92 / $1,388.36
Quartz
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$957.94 / $957.94 / $957.94
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$577.64 / $1,356.75 / $2,350.08
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$903.46 / $1,878.25 / $2,025.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,008.00 / $1,370.00 / $2,202.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.00 / $586.20 / $1,587.94