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Wisconsin rates for HCPCS 25690

Closed Tx Lunate Dislocation W/Manipulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$486.40 / $1,033.49 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$463.17 / $505.33 / $2,218.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,740.00 / $4,780.00 / $7,344.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$462.17 / $1,122.46 / $2,840.37
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,942.50 / $1,942.50 / $1,942.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,314.73 / $1,536.37 / $2,356.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$731.68 / $2,000.75 / $2,273.58
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$464.53 / $614.78 / $1,148.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$486.40 / $959.31 / $5,261.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.25 / $933.08 / $3,716.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.84 / $294.30 / $965.52
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$464.53 / $614.78 / $1,148.33
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$997.10 / $1,214.93 / $1,813.65
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,722.47 / $1,722.47 / $4,754.80
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$936.06 / $2,321.10 / $3,716.08
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,597.31 / $1,597.31 / $1,597.31
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,368.90 / $2,433.73 / $3,184.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,960.00 / $4,155.00 / $5,865.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.25 / $922.76 / $2,119.16