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Montana rates for HCPCS 25274

Repair, tendon or muscle, extensor, forearm and/or wrist; secondary, with free graft (includes obtaining graft), each tendon or muscle

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$706.45 / $941.38 / $3,501.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,065.80 / $1,065.80 / $1,065.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,065.80 / $1,065.80 / $1,065.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.92 / $1,065.80 / $1,123.83
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.05 / $728.84 / $1,065.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.21 / $1,065.80 / $1,385.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$944.01 / $1,100.26 / $1,228.16