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Wisconsin rates for HCPCS 25909

Amp Forearm Thru Radius&Ulna Re-Amputation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$667.65 / $1,410.34 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$639.65 / $697.39 / $3,120.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,057.00 / $7,774.00 / $12,204.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$652.48 / $1,540.73 / $3,919.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,781.51 / $2,081.84 / $3,193.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,088.85 / $2,728.87 / $3,100.99
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$667.65 / $940.23 / $1,475.51
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$667.65 / $1,347.66 / $8,384.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$775.75 / $1,445.91 / $5,361.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.47 / $401.29 / $1,321.93
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$667.65 / $934.71 / $1,475.51
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,370.20 / $1,669.54 / $2,492.29
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,132.00 / $17,132.00 / $17,132.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,276.73 / $3,263.60 / $5,361.75
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,204.21 / $2,204.21 / $2,204.21
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.57 / $3,379.58 / $4,342.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,103.00 / $6,477.00 / $8,384.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$749.54 / $1,389.42 / $3,131.95