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Indiana rates for HCPCS 25920

Disarticulation Through Wrist

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$682.44 / $1,386.00 / $4,846.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$609.12 / $682.44 / $921.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,800.00 / $19,595.20 / $27,445.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$577.32 / $821.70 / $1,133.94
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$675.86 / $927.65 / $1,391.48
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.61 / $828.26 / $1,192.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.68 / $915.55 / $1,416.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,058.00 / $12,330.00 / $17,416.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$559.16 / $755.73 / $1,374.70