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Idaho rates for HCPCS 25275

Repair, tendon sheath, extensor, forearm and/or wrist, with free graft (includes obtaining graft) (eg, for extensor carpi ulnaris subluxation)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,952.80 / $4,500.00 / $8,622.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,895.78 / $1,895.78 / $1,901.11
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.85 / $1,179.86 / $1,597.41
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,834.98 / $7,849.65 / $9,927.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,500.00 / $9,360.00 / $17,870.00