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Montana 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
$7,096.50 / $7,096.50 / $7,096.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.42 / $1,078.42 / $1,078.42
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$535.48 / $736.29 / $1,078.42