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Wisconsin rates for HCPCS 51725

Simple cystometrogram (CMG) (eg, spinal manometer)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$76.69 / $153.44 / $273.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.69 / $236.85 / $1,144.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.42 / $571.64 / $1,466.54
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$192.84 / $225.35 / $363.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.54 / $722.17 / $890.58
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.12 / $572.08 / $1,260.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.84 / $210.86 / $495.68
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$403.65 / $621.00 / $759.09
Quartz
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$339.11 / $339.11 / $339.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.82 / $1,031.25 / $1,687.36
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.24 / $1,365.52 / $1,365.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.37 / $593.75 / $1,029.29