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Washington rates for HCPCS 25924

Disarticulation Thru Wrist Re-Amputation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$923.16 / $1,895.90 / $22,024.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$666.77 / $923.16 / $1,895.90
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$991.69 / $18,220.34 / $35,644.43
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.77 / $1,663.00 / $6,316.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$714.97 / $765.00 / $870.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$708.30 / $1,300.25 / $2,198.55
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$650.69 / $1,329.21 / $1,882.17
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$650.69 / $1,310.70 / $1,736.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.68 / $398.50 / $1,419.70
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$924.43 / $1,278.35 / $1,453.90
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$969.42 / $969.42 / $991.69
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,108.56 / $1,577.59 / $1,968.41
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,233.34 / $18,633.84 / $35,644.43
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$988.68 / $1,411.54 / $1,879.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,028.00 / $5,547.00 / $19,271.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$804.50 / $1,125.04 / $2,018.04
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.82 / $601.82 / $788.48