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Virginia 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
Facility
Modifier
Low / Median / High Price
$1,162.38 / $5,360.00 / $9,347.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.16 / $702.70 / $947.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,032.00 / $6,548.00 / $7,221.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$622.94 / $796.61 / $1,317.03
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$715.67 / $760.88 / $6,433.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$763.31 / $763.31 / $776.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.34 / $960.35 / $1,458.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.19 / $827.12 / $976.14
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$695.75 / $895.85 / $1,370.40
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$823.00 / $995.00 / $1,300.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$665.18 / $917.27 / $2,898.44
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$665.18 / $917.27 / $2,898.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,121.00 / $9,270.00 / $17,192.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$547.29 / $882.51 / $1,458.73