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Pennsylvania rates for HCPCS 25675

Closed treatment of distal radioulnar dislocation with manipulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$315.77 / $321.52 / $356.51
Cigna
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$501.95 / $501.95 / $501.95
Martin's Point
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$321.52 / $321.52 / $356.51
Priority Health
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$501.95 / $501.95 / $501.95