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South Carolina rates for HCPCS 25690

Closed treatment of lunate dislocation, with manipulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $4,897.79 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $512.86 / $912.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $4,265.80 / $8,128.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $537.03 / $794.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $575.44 / $1,380.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $602.56 / $1,071.52
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $1,148.15
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $616.60 / $1,071.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $6,760.83 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $501.19 / $812.83