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Indiana 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
$629.65 / $1,734.24 / $14,063.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,807.00 / $7,833.00 / $14,645.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$629.44 / $863.94 / $1,295.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,116.34 / $2,116.34 / $2,508.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,932.00 / $8,348.00 / $12,569.00