| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $669.13 | $669.13 | $8,500.00 | |
Medica
| Facility | $669.13 | $882.85 | $1,159.74 |
Repair, tendon sheath, extensor, forearm and/or wrist, with free graft (includes obtaining graft) (eg, for extensor carpi ulnaris subluxation)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $669.13 | $669.13 | $8,500.00 | |
Medica
| Facility | $669.13 | $882.85 | $1,159.74 |