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Illinois rates for HCPCS 25924

Disarticulation through wrist; re-amputation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $3,090.30 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $758.58 / $1,548.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,168.69 / $5,128.61 / $15,848.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,000.00 / $1,412.54
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,230.27 / $2,691.53
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $912.01 / $1,000.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $776.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $7,079.46 / $14,454.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $831.76 / $1,412.54