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Illinois rates for HCPCS 25924

Disarticulation Thru Wrist Re-Amputation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$755.00 / $1,662.20 / $5,430.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$604.94 / $730.41 / $1,266.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,457.59 / $9,534.95 / $19,093.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.00 / $875.00 / $908.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$698.85 / $1,043.10 / $1,441.43
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.87 / $1,189.27 / $2,575.21
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
$845.83 / $904.12 / $1,007.18
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $1,138.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,537.00 / $6,885.00 / $14,716.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$651.41 / $877.49 / $1,516.89