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Washington rates for HCPCS 25690

Closed Tx Lunate Dislocation W/Manipulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$918.74 / $2,769.52 / $18,711.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$463.17 / $641.08 / $1,340.02
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,613.81 / $4,554.63 / $11,500.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$715.95 / $1,154.08 / $4,433.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$466.83 / $568.48 / $1,985.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$486.90 / $905.03 / $1,545.21
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$485.89 / $997.37 / $1,741.30
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.59 / $985.08 / $1,575.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.14 / $301.83 / $1,032.04
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$667.87 / $912.54 / $1,019.74
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.44 / $667.72 / $1,613.81
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$770.04 / $1,106.49 / $1,380.61
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,953.48 / $4,552.03 / $8,712.50
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$680.99 / $990.03 / $1,318.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.00 / $1,436.00 / $6,857.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$570.42 / $797.99 / $1,424.05
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.49 / $423.49 / $558.84